Provider Demographics
NPI:1033125380
Name:GERDELMAN, BRENNA K (MD)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:K
Last Name:GERDELMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-681-5901
Mailing Address - Fax:512-681-5921
Practice Address - Street 1:5145 FM 620 N BLDG I
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-1839
Practice Address - Country:US
Practice Address - Phone:512-681-5901
Practice Address - Fax:512-681-5921
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186540403Medicaid
TX186540401Medicaid
P01456795OtherRRMC PTAN
TX186540402Medicaid
TX8J3024Medicare PIN
TX344378YNBVMedicare PIN
TXP00941012Medicare PIN
TX8J3023Medicare PIN