Provider Demographics
NPI:1306892567
Name:BRENNER, ADAM MARSHALL (MD)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:MARSHALL
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:PO BOX 845347
Mailing Address - Street 2:DEPT. PSYCHIATRY, UT SOUTHWESTERN MED CTR.
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-648-7312
Mailing Address - Fax:214-648-7370
Practice Address - Street 1:5323 HARRY HINES BLVD.
Practice Address - Street 2:STE. NC5.802
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9070
Practice Address - Country:US
Practice Address - Phone:214-648-7312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA748752084P0800X
TXM47202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183064801Medicaid
TX8G9760Medicare PIN
8G9760Medicare PIN