Healthcare Provider Details

I. General information

NPI: 1376536920
Provider Name (Legal Business Name): BRIAN A BRENNAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 1ST ST
MORRIS MN
56267-1408
US

IV. Provider business mailing address

400 E 1ST ST
MORRIS MN
56267-1408
US

V. Phone/Fax

Practice location:
  • Phone: 320-589-1313
  • Fax: 320-589-1065
Mailing address:
  • Phone: 320-589-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5795
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number5795
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: