Healthcare Provider Details

I. General information

NPI: 1518501766
Provider Name (Legal Business Name): MAXWELL WILLIAM BRAUNSTEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11410 JOLLYVILLE RD STE 1101
AUSTIN TX
78759-4093
US

IV. Provider business mailing address

8240 N MOPAC EXPY STE 100
AUSTIN TX
78759-8869
US

V. Phone/Fax

Practice location:
  • Phone: 122-311-4445
  • Fax: 512-231-7051
Mailing address:
  • Phone: 512-687-1970
  • Fax: 512-407-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15038
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: