Basic Information
Provider Information
NPI: 1649931924
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BUHRER
FirstName: BRIAN
MiddleName: JACOB
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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: 5122311444
FaxNumber: 5122317051
Other Information
ProviderEnumerationDate: 01/07/2022
LastUpdateDate: 01/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X  Y Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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