Provider Demographics
NPI:1336123173
Name:BRENNAN, JOHN MICHAEL (MD, PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7859 WALNUT HILL LN
Mailing Address - Street 2:STE 350
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5605
Mailing Address - Country:US
Mailing Address - Phone:214-824-2273
Mailing Address - Fax:214-826-9340
Practice Address - Street 1:9101 N CENTRAL EXPY
Practice Address - Street 2:SUITE 590
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5927
Practice Address - Country:US
Practice Address - Phone:214-824-2273
Practice Address - Fax:214-826-9340
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ37502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0359267-01Medicaid
TX4480010OtherAETNA
TX4480010OtherAETNA
TX00T03BMedicare PIN