Doctor Name: | JEFFREY GERARD BRENNER |
NPI Number: | 1295863314 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 5601001774 |
Business Practice Address: | 400 E Main St Ste 200 Springport, MI - 492849774 |
Business Phone Number: | 5178574500 |
Business Fax Number: | 5178574510 |
Mailing Address: | 400 E Main St, Ste 200 SPRINGPORT |
State: | MI |
Postal Code: | 492849774 |
Phone Number: | 5178574500 |
Fax Number: | 5178574510 |
NPI Enumeration Date: | 03/01/2007 |
NPI Last Update Date: | 02/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 5601001774 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |