MEDICARE: BRENDA DENNERT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	21159	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235127846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA DENNERT M.D.

Provider Business Mailing Address
First Line	:	3020 E CAMELBACK RD
Second Line	:	SUITE 301
City	:	PHOENIX
State	:	AZ
Zip	:	85016-5059
Country	:	US
Telephone Number	:	602-254-5321
Fax Number	:	602-254-6582

Provider Business Practice Location Address
First Line	:	1300 N 12TH ST
Second Line	:	SUITE 608
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2848
Country	:	US
Telephone Number	:	602-254-5321
Fax Number	:	602-254-6582

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	02/16/2017

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