Healthcare Provider Details

I. General information

NPI: 1598430548
Provider Name (Legal Business Name): JUAN ANDRES BRUBAKER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 SW WILSHIRE BLVD
BURLESON TX
76028-8338
US

IV. Provider business mailing address

500 UNIVERSITY DRIVE
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 817-916-5180
  • Fax: 817-916-5199
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: