Provider Demographics
NPI:1225010317
Name:BRENNER, LAWRENCE DAVID (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:DAVID
Last Name:BRENNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2314
Mailing Address - Country:US
Mailing Address - Phone:361-883-3962
Mailing Address - Fax:361-883-6563
Practice Address - Street 1:1202 3RD ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2314
Practice Address - Country:US
Practice Address - Phone:361-883-3962
Practice Address - Fax:361-883-6563
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7249207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F54866Medicare UPIN