Provider Demographics
NPI:1881889475
Name:LAURENCE H BRENNER MD PA
Entity type:Organization
Organization Name:LAURENCE H BRENNER MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:
Authorized Official - Last Name:GREED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-339-4263
Mailing Address - Street 1:687 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2515
Mailing Address - Country:US
Mailing Address - Phone:407-339-4263
Mailing Address - Fax:407-339-4267
Practice Address - Street 1:687 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2515
Practice Address - Country:US
Practice Address - Phone:407-339-4263
Practice Address - Fax:407-339-4267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME918642082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274526700Medicaid
FL52154AOtherMEDICARE INDIVIDUAL PROV#
FL1306894753OtherINDIVIDUAL PROVIDER NPI
FLA59993Medicare UPIN
FLK7473Medicare PIN
FL274526700Medicaid
52154ZMedicare PIN