Provider Demographics
NPI:1447597034
Name:BOOTH, BRENDA LEIGH (OPA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEIGH
Last Name:BOOTH
Suffix:
Gender:F
Credentials:OPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14090 SOUTHWEST FWY STE 130
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3683
Mailing Address - Country:US
Mailing Address - Phone:281-491-7111
Mailing Address - Fax:281-491-0033
Practice Address - Street 1:14090 SOUTHWEST FWY STE 130
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3683
Practice Address - Country:US
Practice Address - Phone:281-491-7111
Practice Address - Fax:281-491-0033
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1119363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical