MEDICARE: BRENTON LYNN HARRIS MD

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	2085R0202X	Diagnostic Radiology Physician	MD29130	ME
2	2085R0202X	Diagnostic Radiology Physician	36394	IA
3	2085R0202X	Diagnostic Radiology Physician	103216	GA
4	2085R0202X	Diagnostic Radiology Physician	01095516A	IN

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
2	72104	OTHER	IA	WELLMARK

General Provider Information

NPI Number	:	1578773032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENTON LYNN HARRIS MD

Provider Business Mailing Address
First Line	:	1948 1ST AVE NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-5340
Country	:	US
Telephone Number	:	319-364-0121
Fax Number	:	319-364-5684

Provider Business Practice Location Address
First Line	:	1948 1ST AVENUE NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-5342
Country	:	US
Telephone Number	:	319-364-0121
Fax Number	:	319-364-5684

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	03/10/2026

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