Basic Information
| Provider Information | |||||||||
| NPI: | 1265882807 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEBER | ||||||||
| FirstName: | BRENNAN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 PEASE ST | ||||||||
| Address2: | |||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785508307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563891100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4300 MARKETPOINTE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554355435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528359880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2016 | ||||||||
| LastUpdateDate: | 07/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | S5292 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 71424 | MN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 5101023497 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.