Basic Information
| Provider Information | |||||||||
| NPI: | 1427002260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRENT | ||||||||
| FirstName: | ELAINE | ||||||||
| MiddleName: | LESLIE | ||||||||
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| Credential: | MS MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9040 REID ST | ||||||||
| Address2: | ATTN: MDHJ QCR, MADIGAN ARMY MEDICAL CENTER | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984311100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539682252 | ||||||||
| FaxNumber: | 2539683278 | ||||||||
| Practice Location | |||||||||
| Address1: | 9040 REID ST | ||||||||
| Address2: | ATTN: MDHJ QCR, MADIGAN ARMY MEDICAL CENTER | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984311100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539682252 | ||||||||
| FaxNumber: | 2539683278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZD0900X | 19500 | AL | Y | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology |
No ID Information.