Provider Demographics
NPI:1164275343
Name:RENNER, BRIAN (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:RENNER
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 S LA CIENEGA BLVD APT 622
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-4165
Mailing Address - Country:US
Mailing Address - Phone:310-658-3492
Mailing Address - Fax:
Practice Address - Street 1:1201 E 36TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4372
Practice Address - Country:US
Practice Address - Phone:907-212-9858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty