Provider Demographics
NPI:1790573186
Name:AYRES, BRENNAN SCOTT (DO)
Entity type:Individual
Prefix:
First Name:BRENNAN
Middle Name:SCOTT
Last Name:AYRES
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 595
Mailing Address - Street 2:
Mailing Address - City:PANORA
Mailing Address - State:IA
Mailing Address - Zip Code:50216-0595
Mailing Address - Country:US
Mailing Address - Phone:515-720-7342
Mailing Address - Fax:
Practice Address - Street 1:20201 S. CRAWFORD
Practice Address - Street 2:ATTN: GRADUATE MEDICAL EDUCATION
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461
Practice Address - Country:US
Practice Address - Phone:708-747-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program