| Wayne Grover Brisbane, MD | |
|
200 Ucla Medical Plz Ste 140, Los Angeles, CA 90095-6410 | |
| (310) 794-7152 | |
| (310) 794-1666 |
| Full Name | Wayne Grover Brisbane |
|---|---|
| Gender | Male |
| Speciality | Urology |
| Experience | 12 Years |
| Location | 200 Ucla Medical Plz Ste 140, Los Angeles, California |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346583176 | NPI | - | NPPES |
| 110701200 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | ME150237 (Florida) | Secondary |
| 208800000X | Urology | A161053 (California) | Primary |
| 208800000X | Urology | ML.60370878 (Washington) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Ronald Reagan Ucla Medical Center | Los angeles, CA | Hospital |
| Santa Monica - Ucla Med Ctr & Orthopaedic Hospital | Santa monica, CA | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| The Regents Of The University Of California | 3678545431 | 42 |
| Entity Name | The Regents Of The University Of California |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1154389799 PECOS PAC ID: 3678545431 Enrollment ID: O20040811000949 |
| Mailing Address | Practice Location Address |
|---|---|
| Wayne Grover Brisbane, MD 5767 W Century Blvd Ste 400, Los Angeles, CA 90045-5631 Ph: () - | Wayne Grover Brisbane, MD 200 Ucla Medical Plz Ste 140, Los Angeles, CA 90095-6410 Ph: (310) 794-7152 |
Dr. Saum Bobak Ghodoussipour, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 1516 San Pablo St Fl 5, Los Angeles, CA 90033 Phone: 323-865-3700 | |
Victor Nitti, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 200 Ucla Medical Plz Ste 140, Los Angeles, CA 90095 Phone: 310-794-7700 Fax: 310-794-0211 | |
Dr. Carol Joan Bennett, M.D. Urology Medicare: Medicare Enrolled Practice Location: 11301 Wilshire Blvd # 10h2, Los Angeles, CA 90073 Phone: 310-478-3711 Fax: 310-268-4967 | |
Arie Belldegrun, MD Urology Medicare: Medicare Enrolled Practice Location: 200 Medical Plz, Suite 140, Los Angeles, CA 90095 Phone: 310-794-7700 Fax: 310-301-8751 | |
Dr. Stuart Holden, Urology Medicare: Accepting Medicare Assignments Practice Location: 200 Ucla Medical Plz Ste 140, Los Angeles, CA 90095 Phone: 310-825-1172 Fax: 310-794-0987 | |
Jay J Stein, M.D. Urology Medicare: Not Enrolled in Medicare Practice Location: 8635 W 3rd St, Suite 460w, Los Angeles, CA 90048 Phone: 310-652-8810 Fax: 310-652-0334 | |
Dr. Philip Werthman, MD Urology Medicare: Not Enrolled in Medicare Practice Location: 2080 Century Park E Ste 907, Los Angeles, CA 90067 Phone: 310-277-2873 Fax: 310-286-2139 |