Provider Demographics
NPI:1174528087
Name:BRENNER, ROBERT L (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
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 1:8833 ENCLAVE CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-4486
Mailing Address - Country:US
Mailing Address - Phone:941-922-8084
Mailing Address - Fax:
Practice Address - Street 1:8833 ENCLAVE CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-4486
Practice Address - Country:US
Practice Address - Phone:941-922-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87091207VG0400X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4067331OtherAETNA PROVIDER #
FLP00133143OtherRR MEDICARE
FLK6204OtherGROUP NUMBER
FLP00389567OtherRAILROAD MEDICARE
FL37900XMedicare PIN
FL4067331OtherAETNA PROVIDER #
FL37900ZMedicare PIN
FLP00389567OtherRAILROAD MEDICARE
FLD76433Medicare UPIN
FL37900WMedicare PIN