Provider Demographics
NPI:1477364719
Name:BRUECKMAN, PAITON LAYNE (PA-C)
Entity type:Individual
Prefix:
First Name:PAITON
Middle Name:LAYNE
Last Name:BRUECKMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45359-8759
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1715 BROWN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2502
Practice Address - Country:US
Practice Address - Phone:937-208-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008948RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant