Provider Demographics
NPI:1649715434
Name:HARTHAN, BRANDON RICHARD (PA-C)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:RICHARD
Last Name:HARTHAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7211 PRESTON RD STE 1200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-0238
Mailing Address - Country:US
Mailing Address - Phone:469-303-3000
Mailing Address - Fax:469-303-4510
Practice Address - Street 1:7211 PRESTON RD STE 1200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-0238
Practice Address - Country:US
Practice Address - Phone:469-303-3000
Practice Address - Fax:469-303-4510
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960041932255A2300X
LA333701363A00000X
TXPA18914363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer