Provider Demographics
NPI:1740381995
Name:ROBERT A BRENNER
Entity Type:Organization
Organization Name:ROBERT A BRENNER
Other - Org Name:ROBERT A BRENNER, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-469-5400
Mailing Address - Street 1:8860 CENTER DRIVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7001
Mailing Address - Country:US
Mailing Address - Phone:619-469-5400
Mailing Address - Fax:619-464-1311
Practice Address - Street 1:8860 CENTER DRIVE
Practice Address - Street 2:SUITE 420
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7001
Practice Address - Country:US
Practice Address - Phone:619-469-5400
Practice Address - Fax:619-464-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51139207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16569Medicare PIN