Provider Demographics
NPI:1003865338
Name:BRENNER, WARREN STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:STEVEN
Last Name:BRENNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6282 LINTON BLVD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6416
Mailing Address - Country:US
Mailing Address - Phone:561-495-8307
Mailing Address - Fax:561-495-6422
Practice Address - Street 1:6282 LINTON BLVD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6416
Practice Address - Country:US
Practice Address - Phone:561-495-8307
Practice Address - Fax:561-495-6422
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94685174400000X, 207RX0202X
FL94685207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH77869Medicare UPIN
MO149050166Medicare ID - Type Unspecified