Healthcare Provider Details

I. General information

NPI: 1104836832
Provider Name (Legal Business Name): EPHRAIM K BRENMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CONCORD PLAZA DR STE 300
SAN ANTONIO TX
78216-6991
US

IV. Provider business mailing address

400 CONCORD PLAZA DR SUITE 300
SAN ANTONIO TX
78216-6905
US

V. Phone/Fax

Practice location:
  • Phone: 210-804-5927
  • Fax: 210-804-5930
Mailing address:
  • Phone: 210-804-5927
  • Fax: 210-804-5930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberL2151
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number34008248
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberL2151
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: