Basic Information
| Provider Information | |||||||||
| NPI: | 1518501766 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAUNSTEIN | ||||||||
| FirstName: | MAXWELL | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8240 N MOPAC EXPY STE 100 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787598869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126871970 | ||||||||
| FaxNumber: | 5124079010 | ||||||||
| Practice Location | |||||||||
| Address1: | 11410 JOLLYVILLE RD STE 1101 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787594093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1223114445 | ||||||||
| FaxNumber: | 5122317051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2019 | ||||||||
| LastUpdateDate: | 10/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363A00000X | 15038 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.