Provider Demographics
NPI:1932535903
Name:BRAUER, PATRICK LYNDON (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:LYNDON
Last Name:BRAUER
Suffix:
Gender:M
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 1:1200 N 14TH AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4166
Mailing Address - Country:US
Mailing Address - Phone:509-545-4800
Mailing Address - Fax:509-545-4861
Practice Address - Street 1:595 CHAPEL HILLS DR STE 240
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1056
Practice Address - Country:US
Practice Address - Phone:719-364-4120
Practice Address - Fax:719-364-4121
Is Sole Proprietor?:No
Enumeration Date:2013-09-22
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005856363A00000X
WAPA60400481363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant