Provider Demographics
NPI:1699159822
Name:TUELLER, BRAUN (DMSC, PA-C)
Entity type:Individual
Prefix:
First Name:BRAUN
Middle Name:
Last Name:TUELLER
Suffix:
Gender:M
Credentials:DMSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 E 2200 N
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040
Mailing Address - Country:US
Mailing Address - Phone:801-663-1929
Mailing Address - Fax:
Practice Address - Street 1:2130 E 2200 N
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-8026
Practice Address - Country:US
Practice Address - Phone:801-663-1929
Practice Address - Fax:877-559-3988
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10121208-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant