Individual
MR. BRANT ALEXANDER VICTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPAS PA-C
Contact information
Practice address
1301 W 38TH ST, MEDICAL PARK TOWER SUITE 102, AUSTIN, TX 78705-1000
(512) 454-4561
(512) 406-7330
Mailing address
4515 SETON CENTER PKWY, SUITE 215-CREDENTIALING, AUSTIN, TX 78759-5290
(512) 231-5516
(512) 406-6216
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
350518201
—
TX
Enumeration date
01/16/2015
Last updated
01/19/2022
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