Basic Information
| Provider Information | |||||||||
| NPI: | 1972572055 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAUNREITER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16811 SOUTHWEST FWY | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774794728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816904678 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16811 SOUTHWEST FWY | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774794728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816904678 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 207QS0010X | K8026 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 047591502 | 05 | TX | MEDICAID | 047591506 | 05 | TX | MEDICAID | 047591507 | 05 | TX | MEDICAID | 047591505 | 05 | TX | MEDICAID | 610119705 BROOKS | 01 | TX | US DEPT OF LABOR | OTHER | 0061LP | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 047591504 | 05 | TX | MEDICAID | 047591503 | 05 | TX | MEDICAID | 047591508 | 05 | TX | MEDICAID | 610119701 | 01 | TX | US DEPT OF LABOR | OTHER | P00976676 | 01 | TX | MEDICARE RR | OTHER | P01078363 | 01 | TX | RR MEDICARE | OTHER |