Healthcare Provider Details

I. General information

NPI: 1659634145
Provider Name (Legal Business Name): JAMES KEENE BRENNAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 ELDORADO AVE
CLEARWATER FL
33767-1421
US

IV. Provider business mailing address

743 ELDORADO AVE
CLEARWATER FL
33767-1421
US

V. Phone/Fax

Practice location:
  • Phone: 727-443-7225
  • Fax: 727-443-7225
Mailing address:
  • Phone: 727-443-7225
  • Fax: 727-443-7225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME 76349
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: