Provider Demographics
NPI:1194791533
Name:FLETCHER, BRENT FARRELL (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:FARRELL
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRENT
Other - Middle Name:FARRELL
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 26517
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92196-0517
Mailing Address - Country:US
Mailing Address - Phone:858-239-2277
Mailing Address - Fax:415-536-2977
Practice Address - Street 1:5755 OBERLIN DR STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4717
Practice Address - Country:US
Practice Address - Phone:858-239-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-26
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA961492084P0804X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry