Provider Demographics
NPI:1215146931
Name:S. BRENT BROTZMAN, MD PA
Entity type:Organization
Organization Name:S. BRENT BROTZMAN, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:BROTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-977-0000
Mailing Address - Street 1:11652 JOLLYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3935
Mailing Address - Country:US
Mailing Address - Phone:512-977-0000
Mailing Address - Fax:512-977-0020
Practice Address - Street 1:11652 JOLLYVILLE RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3935
Practice Address - Country:US
Practice Address - Phone:512-977-0000
Practice Address - Fax:512-977-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6077207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82160XOtherBCBS
TX82160XOtherBCBS