Individual
DR. BRADLEY BRENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12554 RIATA VISTA CIR, AUSTIN, TX 78727-6431
(512) 795-5100
(512) 795-5122
Mailing address
12554 RIATA VISTA CIR, AUSTIN, TX 78727-6431
(512) 795-5100
(512) 795-5122
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
L2152
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
146838102
CSCHN1
TX
05
—
146838102
—
TX
01
—
146838103
CSHCN2
TX
05
—
146838103
—
TX
01
—
P00145598
RRMCARE
—
01
—
P00282122
RRMCARE2
—
Enumeration date
06/09/2005
Last updated
01/12/2015
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