Healthcare Provider Details

I. General information

NPI: 1881889475
Provider Name (Legal Business Name): LAURENCE H BRENNER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 DOUGLAS AVE
ALTAMONTE SPRINGS FL
32714-2515
US

IV. Provider business mailing address

687 DOUGLAS AVE
ALTAMONTE SPRINGS FL
32714-2515
US

V. Phone/Fax

Practice location:
  • Phone: 407-339-4263
  • Fax: 407-339-4267
Mailing address:
  • Phone: 407-339-4263
  • Fax: 407-339-4267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberME91864
License Number StateFL

VIII. Authorized Official

Name: DOLORES GREED
Title or Position: OFFICE MANAGER
Credential:
Phone: 407-339-4263