Healthcare Provider Details

I. General information

NPI: 1265449623
Provider Name (Legal Business Name): MARY JANE EMILY BRAUNSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 RESEARCH BLVD SUITE 230
AUSTIN TX
78759-5264
US

IV. Provider business mailing address

205 E UNIVERSITY AVE
GEORGETOWN TX
78626-6814
US

V. Phone/Fax

Practice location:
  • Phone: 512-795-4620
  • Fax:
Mailing address:
  • Phone: 512-454-5721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberJ6347
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: