Provider Demographics
NPI:1639282064
Name:ROBERT BRENNER, MD, PA
Entity Type:Organization
Organization Name:ROBERT BRENNER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-922-8084
Mailing Address - Street 1:8833 ENCLAVE CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-4486
Mailing Address - Country:US
Mailing Address - Phone:941-922-8084
Mailing Address - Fax:
Practice Address - Street 1:8833 ENCLAVE CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-4486
Practice Address - Country:US
Practice Address - Phone:941-922-8084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6204 37900ZMedicare ID - Type Unspecified
FLD76433Medicare UPIN