Provider Demographics
NPI:1760611305
Name:BRENNER, JENNIFER W (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:W
Last Name:BRENNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 N OGDEN ST.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1022
Mailing Address - Country:US
Mailing Address - Phone:303-861-0808
Mailing Address - Fax:303-861-2193
Practice Address - Street 1:1960 N OGDEN ST
Practice Address - Street 2:SUITE 220
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1022
Practice Address - Country:US
Practice Address - Phone:303-861-0808
Practice Address - Fax:303-861-2193
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47735207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO65736770Medicaid
CO305243Medicare UPIN
C305243Medicare UPIN