Provider Demographics
NPI:1518501766
Name:BRAUNSTEIN, MAXWELL WILLIAM
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:WILLIAM
Last Name:BRAUNSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 N MOPAC EXPY STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8869
Mailing Address - Country:US
Mailing Address - Phone:512-687-1970
Mailing Address - Fax:512-407-9010
Practice Address - Street 1:11410 JOLLYVILLE RD STE 1101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4093
Practice Address - Country:US
Practice Address - Phone:122-311-4445
Practice Address - Fax:512-231-7051
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX15038363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program