Healthcare Provider Details

I. General information

NPI: 1376581397
Provider Name (Legal Business Name): DOUGLAS C BRENGLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 EDWARDS RD STE. 300
CINCINNATI OH
45209-1900
US

IV. Provider business mailing address

3805 EDWARDS RD SUITE 300
CINCINNATI OH
45209-1900
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-9700
  • Fax:
Mailing address:
  • Phone: 513-585-9700
  • Fax: 513-585-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35059785B
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: