Provider Demographics
NPI:1922372036
Name:BRAUN, BEAU D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BEAU
Middle Name:D
Last Name:BRAUN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:605-328-6512
Practice Address - Street 1:300 S BYRON BLVD
Practice Address - Street 2:
Practice Address - City:CHAMBERLAIN
Practice Address - State:SD
Practice Address - Zip Code:57325-9741
Practice Address - Country:US
Practice Address - Phone:605-234-6551
Practice Address - Fax:605-234-7260
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0806363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant