Provider Demographics
NPI:1659634145
Name:BRENNAN, JAMES KEENE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KEENE
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 ELDORADO AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33767-1421
Mailing Address - Country:US
Mailing Address - Phone:727-443-7225
Mailing Address - Fax:727-443-7225
Practice Address - Street 1:743 ELDORADO AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33767-1421
Practice Address - Country:US
Practice Address - Phone:727-443-7225
Practice Address - Fax:727-443-7225
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 76349207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$AMedicare PIN