Provider Demographics
NPI:1952834368
Name:LABERE, BRENNA ASHLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENNA
Middle Name:ASHLEY
Last Name:LABERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:ASHLEY
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2108 E THOMAS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-0008
Mailing Address - Country:US
Mailing Address - Phone:602-933-3124
Mailing Address - Fax:
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-4063
Practice Address - Fax:602-933-2423
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10955741-1205208000000X
AZ67710207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics