Provider Demographics
NPI:1780670497
Name:BRENNEMAN, ANTHONY E (PA-C)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:E
Last Name:BRENNEMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DRIVE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1082
Mailing Address - Country:US
Mailing Address - Phone:319-335-8896
Mailing Address - Fax:319-335-8923
Practice Address - Street 1:200 HAWKINS DRIVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1082
Practice Address - Country:US
Practice Address - Phone:319-335-8896
Practice Address - Fax:319-335-8923
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001048363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA48729OtherWELLMARK BCBS
IA48729OtherWELLMARK BCBS
S79334Medicare UPIN