Healthcare Provider Details

I. General information

NPI: 1053793976
Provider Name (Legal Business Name): BRENDAN MCDANIEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2015
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E 3RD ST
DELTA CO
81416-2815
US

IV. Provider business mailing address

PO BOX 5607
DENVER CO
80217-5607
US

V. Phone/Fax

Practice location:
  • Phone: 970-546-4007
  • Fax:
Mailing address:
  • Phone: 303-306-7783
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0062925
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMT208772
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: