1174670749 NPI number — SHINEE P BRAUER L.P.C

Table of content: SHINEE P BRAUER L.P.C (NPI 1174670749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174670749 NPI number — SHINEE P BRAUER L.P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAUER
Provider First Name:
SHINEE
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.P.C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174670749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
664 NAUTICA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77316-7401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-787-6808
Provider Business Mailing Address Fax Number:
832-565-8989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14011 PARK DR
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
TOMBALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77377-6292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-787-6808
Provider Business Practice Location Address Fax Number:
832-565-8989
Provider Enumeration Date:
01/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  11564 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)