Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | ME91864 | FL |
N | 2086S0122X | Plastic and Reconstructive Surgery | ME91864 | FL |
NPI | 1306894753 |
---|---|
Provider Name | Dr. Laurence Harvey Brenner |
First Address | Deland, FL 32724-7352 |
Second Address | Lake Mary, FL 32746-3589 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 02/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
274526700 | (05) | FL |
52154A | MEDICARE PROVIDER (01) | FL |
6137800001 | MEDICARE NSC (01) | FL |
A59993 | (02) | |
K7473 | MEDICARE GROUP PROVIDER (01) | FL |