Provider Demographics
NPI:1427002260
Name:BRENT, ELAINE LESLIE (MS MD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:LESLIE
Last Name:BRENT
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Gender:F
Credentials:MS MD
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Mailing Address - Street 1:9040 REID ST
Mailing Address - Street 2:ATTN: MDHJ QCR, MADIGAN ARMY MEDICAL CENTER
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1100
Mailing Address - Country:US
Mailing Address - Phone:253-968-2252
Mailing Address - Fax:253-968-3278
Practice Address - Street 1:9040 REID ST
Practice Address - Street 2:ATTN: MDHJ QCR, MADIGAN ARMY MEDICAL CENTER
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-2252
Practice Address - Fax:253-968-3278
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
AL19500207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology