Healthcare Provider Details

I. General information

NPI: 1518201268
Provider Name (Legal Business Name): DAVID STUART BRAUN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15240 W 64TH AVE
ARVADA CO
80007-7511
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-364-9560
  • Fax: 719-364-7680
Mailing address:
  • Phone: 970-624-2417
  • Fax: 970-652-2927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0003600
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0003600
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: