Provider Demographics
NPI:1750561973
Name:BRENNER, DANIEL ADAM (MD / PHD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ADAM
Last Name:BRENNER
Suffix:
Gender:M
Credentials:MD / PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:34 MARK WEST SPRINGS RD STE 310
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1783
Mailing Address - Country:US
Mailing Address - Phone:617-573-5200
Mailing Address - Fax:808-576-5417
Practice Address - Street 1:34 MARK WEST SPRINGS RD STE 310
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:617-573-5200
Practice Address - Fax:808-576-5417
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105376207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease