Basic Information
| Provider Information | |||||||||
| NPI: | 1932535903 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAUER | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | LYNDON | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N 14TH AVE STE 350 | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993014166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095454800 | ||||||||
| FaxNumber: | 5095454861 | ||||||||
| Practice Location | |||||||||
| Address1: | 595 CHAPEL HILLS DR STE 240 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809201056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193644120 | ||||||||
| FaxNumber: | 7193644121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2013 | ||||||||
| LastUpdateDate: | 07/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.0005856 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | PA60400481 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.