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Individual
DR. BRENT A ENNISS
Active
Individual
DR. BRENT A ENNISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207ZB0001X
Blood Banking & Transfusion Medicine Physician
1337
NE
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
DR.0068949
CO
208D00000X
General Practice Physician
BP10048437
TX
Other
Enumeration date
06/13/2013
Last updated
11/01/2022
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