Healthcare Provider Details

I. General information

NPI: 1578535563
Provider Name (Legal Business Name): BRUCE HOWARD BRENNAMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 18TH ST
COLUMBUS GA
31901-1524
US

IV. Provider business mailing address

PO BOX 1038
COLUMBUS GA
31902-1038
US

V. Phone/Fax

Practice location:
  • Phone: 706-649-6600
  • Fax: 706-649-6614
Mailing address:
  • Phone: 706-660-6148
  • Fax: 706-660-2843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number31709
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number31709
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: