Provider Demographics
NPI:1295813681
Name:CLAIRE E BRENNER MD PA
Entity Type:Organization
Organization Name:CLAIRE E BRENNER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-494-1155
Mailing Address - Street 1:9330 LBJ FWY STE 800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4310
Mailing Address - Country:US
Mailing Address - Phone:972-792-5700
Mailing Address - Fax:214-506-1170
Practice Address - Street 1:2241 PEGGY LN STE E
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5709
Practice Address - Country:US
Practice Address - Phone:972-494-1155
Practice Address - Fax:972-494-6572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174981401Medicaid
TX0050PSOtherBCBS
TX174981401Medicaid