Healthcare Provider Details

I. General information

NPI: 1306887906
Provider Name (Legal Business Name): DAVID BRENNAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2745 LINCOLN WAY CLINTON
CLINTON IA
52732-7201
US

IV. Provider business mailing address

2745 LINCOLN WAY
CLINTON IA
52732-7201
US

V. Phone/Fax

Practice location:
  • Phone: 563-242-3208
  • Fax: 563-242-4051
Mailing address:
  • Phone: 563-242-3208
  • Fax: 563-242-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02378
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: