Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 28201 | AZ |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 28201 | AZ |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 65654 | MT |
NPI | 1003812660 |
---|---|
Provider Name | Edmund J Brennan |
First Address | Great Falls, MT 59405-5161 |
Second Address | Great Falls, MT 59405-5161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 25/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060057219 | RAILROAD MEDICARE (01) | AZ |
1Z5173 | HEALTHNET (01) | AZ |
2500514 | UNITED HEALTHCARE (01) | AZ |
500711 | (05) | AZ |
AZ0863440 | BLUE CROSS BLUE SHIELD (01) | AZ |
E51130 | (02) | AZ |