MEDICARE: PAITON LAYNE BRUECKMAN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50.008948RX	OH

General Provider Information

NPI Number	:	1477364719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAITON LAYNE BRUECKMAN PA-C

Provider Business Mailing Address
First Line	:	7001 THOMAS RD
Second Line	:
City	:	PLEASANT HILL
State	:	OH
Zip	:	45359-8759
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 BROWN ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-2502
Country	:	US
Telephone Number	:	937-208-9010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	01/16/2025

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