Individual
MARK BRENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2946 E BANNER GATEWAY DRIVE, GILBERT, AZ 85234
(480) 256-6444
(480) 256-4734
Mailing address
2940 E. BANNER GATEWAY DRIVE, SUITE #450, GILBERT, AZ 85234
(480) 256-6444
(480) 256-4734
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
2207
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1Z0539
HEALTHNET
AZ
05
—
258914
—
AZ
01
—
4316747
AETNA
AZ
01
—
AZ0063470
BLUECROSSBLUESHIELDAZ
AZ
Enumeration date
08/05/2006
Last updated
05/18/2016
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