Provider Demographics
NPI:1326087024
Name:BRENNAN, ROBERT ALEXIS (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALEXIS
Last Name:BRENNAN
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 1:13023 TESSON FERRY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3480
Mailing Address - Country:US
Mailing Address - Phone:314-849-3711
Mailing Address - Fax:314-849-0235
Practice Address - Street 1:13023 TESSON FERRY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3480
Practice Address - Country:US
Practice Address - Phone:314-849-3711
Practice Address - Fax:314-849-0235
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR7047207V00000X
IL336-068943207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201585304Medicaid
MOA09560Medicare UPIN
MO000000014Medicare ID - Type Unspecified