Provider Demographics
NPI:1326126749
Name:BRAUN, OPTA LEA (MD)
Entity Type:Individual
Prefix:
First Name:OPTA
Middle Name:LEA
Last Name:BRAUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 N HALL ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219
Mailing Address - Country:US
Mailing Address - Phone:214-698-1081
Mailing Address - Fax:214-526-1214
Practice Address - Street 1:3626 N HALL ST
Practice Address - Street 2:SUITE 900
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219
Practice Address - Country:US
Practice Address - Phone:214-698-1081
Practice Address - Fax:214-526-1214
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8155207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116020201Medicaid
TX00T522Medicare PIN
C13722Medicare UPIN