Healthcare Provider Details

I. General information

NPI: 1265882807
Provider Name (Legal Business Name): BRENNAN WEBER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 MARKETPOINTE DR STE 100
BLOOMINGTON MN
55435-5435
US

IV. Provider business mailing address

2101 PEASE ST
HARLINGEN TX
78550-8307
US

V. Phone/Fax

Practice location:
  • Phone: 952-835-9880
  • Fax:
Mailing address:
  • Phone: 956-389-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberS5292
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101023497
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number71424
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: