Healthcare Provider Details

I. General information

NPI: 1215146931
Provider Name (Legal Business Name): S. BRENT BROTZMAN, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11652 JOLLYVILLE RD
AUSTIN TX
78759-3935
US

IV. Provider business mailing address

11652 JOLLYVILLE RD
AUSTIN TX
78759-3935
US

V. Phone/Fax

Practice location:
  • Phone: 512-977-0000
  • Fax: 512-977-0020
Mailing address:
  • Phone: 512-977-0000
  • Fax: 512-977-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberH6077
License Number StateTX

VIII. Authorized Official

Name: STEVEN BRENT BROTZMAN
Title or Position: DOCTOR
Credential: MD
Phone: 512-977-0000