Provider Demographics
NPI:1235127846
Name:DENNERT, BRENDA (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:DENNERT
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 1:3020 E CAMELBACK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5059
Mailing Address - Country:US
Mailing Address - Phone:602-254-5321
Mailing Address - Fax:602-254-6582
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:SUITE 608
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2848
Practice Address - Country:US
Practice Address - Phone:602-254-5321
Practice Address - Fax:602-254-6582
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21159207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ334681Medicaid
G20036Medicare UPIN
10WCHWR06Medicare ID - Type Unspecified