Individual
DR. BRENT LEE MAINWARING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3405 COLLEGE ST, BEAUMONT, TX 77701-4613
(409) 832-2211
Mailing address
1129 MOORE RD, BEAUMONT, TX 77713-3918
(409) 656-6951
(409) 753-3873
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
H7781
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00TF2E
BC/BS
TX
05
—
136949801
—
TX
Enumeration date
06/12/2006
Last updated
07/14/2011
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