Provider Demographics
NPI:1740401876
Name:BRENT, ALVIN E JR (MD)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:E
Last Name:BRENT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:108 OVERLOOK POINT DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39157
Mailing Address - Country:US
Mailing Address - Phone:304-525-4202
Mailing Address - Fax:304-525-4231
Practice Address - Street 1:612 6TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2104
Practice Address - Country:US
Practice Address - Phone:304-525-4202
Practice Address - Fax:304-525-4231
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS4790207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSB30891Medicare UPIN