Healthcare Provider Details

I. General information

NPI: 1043282767
Provider Name (Legal Business Name): FRED H BRENNAN JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 N MYRTLE AVE
CLEARWATER FL
33755-4254
US

IV. Provider business mailing address

807 N MYRTLE AVE
CLEARWATER FL
33755-4254
US

V. Phone/Fax

Practice location:
  • Phone: 727-467-2400
  • Fax: 727-467-2477
Mailing address:
  • Phone: 727-467-2400
  • Fax: 727-467-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13446
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number13446
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0102201136
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2066
License Number StateME
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS14442
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: