Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 13446 | NH |
Y | 207Q00000X | Family Doctor | OS14442 | FL |
N | 207QS0010X | Family Doctor - Sports Medicine | 0102201136 | VA |
N | 207QS0010X | Family Doctor - Sports Medicine | 13446 | NH |
N | 207QS0010X | Family Doctor - Sports Medicine | 2066 | ME |
NPI | 1043282767 |
---|---|
Provider Name | Dr. Fred H Brennan JR. |
First Address | Clearwater, FL 33757-8744 |
Second Address | Clearwater, FL 33755-4254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 20/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021438100 | (05) | FL |
30225211 | (05) | NH |
432690199 | (05) | ME |
G30138 | (02) | NH |