Provider Demographics
NPI:1609832617
Name:BRENNER, JAY ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:ALLAN
Last Name:BRENNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PEDIATRIX MEDICAL GROUP
Mailing Address - Street 2:621 SOUTH NEW BALLAS RD SUITE 2016 B
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-251-5860
Mailing Address - Fax:
Practice Address - Street 1:ST. JOHN'S MERCY MEDICAL CENTER
Practice Address - Street 2:615 SOUTH NEW BALLAS
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-251-6450
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR8E412080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine