Individual
DR. CHARLES B BRENTNALL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., P.A.
Contact information
Practice address
7 BROWN AVE, SYLACAUGA, AL 35150-2421
(256) 249-0358
(256) 249-8508
Mailing address
PO BOX 2190, SYLACAUGA, AL 35150-5190
(256) 249-0358
(256) 249-8508
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
00007246
AL
207N00000X
Dermatology Physician
00007246
AL
207NP0225X
Pediatric Dermatology Physician
00007246
AL
207Y00000X
Otolaryngology Physician
00007246
AL
208600000X
Surgery Physician
00007246
AL
2086S0122X
Plastic and Reconstructive Surgery Physician
00007246
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
510-02286
BLUE CROSS AND BLUE SHIED
AL
01
—
510-19927
BLUECROSS/BLUE SHIELD
AL
Enumeration date
06/27/2005
Last updated
04/04/2008
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