Provider Demographics
NPI:1841391141
Name:BRENNER, ANNE MANON (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MANON
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 1:6453 SOUTH DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80121-2517
Mailing Address - Country:US
Mailing Address - Phone:303-795-2282
Mailing Address - Fax:703-795-2282
Practice Address - Street 1:6453 SOUTH DOWNING ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80121-2517
Practice Address - Country:US
Practice Address - Phone:303-795-2282
Practice Address - Fax:703-795-2282
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21346207K00000X, 208000000X, 208D00000X
TXD8157207K00000X, 208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01213461Medicaid
CO01213461Medicaid