Provider Demographics
NPI:1861808727
Name:NEAL, BRETT (PA-C)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:NEAL
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 1:3500 JEFFERSON ST
Mailing Address - Street 2:STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6200
Mailing Address - Country:US
Mailing Address - Phone:512-451-0139
Mailing Address - Fax:512-323-5880
Practice Address - Street 1:601 E 15TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1930
Practice Address - Country:US
Practice Address - Phone:512-324-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017694363AS0400X
TXPA10578363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX365787601Medicaid
TX537414YMGJMedicare PIN