Provider Demographics
NPI:1518628411
Name:BOOTS, AUSTIN HENRY
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:HENRY
Last Name:BOOTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 BRIARMONT AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-3680
Mailing Address - Country:US
Mailing Address - Phone:573-915-2733
Mailing Address - Fax:
Practice Address - Street 1:3625 BRIARMONT AVE APT 208
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-3680
Practice Address - Country:US
Practice Address - Phone:573-915-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program