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General NPI Number Information
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NPI Number | 1619111853
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Entity Type | Individual
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Provider Name | RYAN PATRICK BRENNAN M.D
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Gender | Male
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Dates
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Enumeration Date | 04/30/2009
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 4800 MAINE ST
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City | QUINCY
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State | IL
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Zip | 62305-5875
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Country | US
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Telephone | 217-214-9620
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Fax | 217-214-5678
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Provider Business Mailing Address
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Address Line | 1005 BROADWAY ST
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City | QUINCY
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State | IL
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Zip | 62301-2834
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Country | US
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Telephone | 217-223-8400
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Fax | 217-277-3960
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 60633008
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 036164832
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License Number State | IL
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