Healthcare Provider Details

I. General information

NPI: 1679664932
Provider Name (Legal Business Name): BRUCE RANDALL BRENN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 TVC
NASHVILLE TN
37232-3607
US

IV. Provider business mailing address

3601 TVC NASHVILLE
NASHVILLE TN
37232-0001
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-3000
  • Fax:
Mailing address:
  • Phone: 615-322-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number56336
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC10004086
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberC10004086
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number56336
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: