Provider Demographics
NPI:1710071568
Name:MORLEY, BRENDAN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:PATRICK
Last Name:MORLEY
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 1:1335 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2536
Mailing Address - Country:US
Mailing Address - Phone:510-649-7000
Mailing Address - Fax:510-649-7010
Practice Address - Street 1:1335 STANFORD AVE
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2536
Practice Address - Country:US
Practice Address - Phone:510-649-7000
Practice Address - Fax:510-649-7010
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74102207L00000X, 207LP2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ20562ZOtherMEDICARE GROUP PROVIDER NUMBER
CA050079559OtherRAILROAD MEDICARE
CA00G741020OtherBLUE SHIELD OF CALIFORNIA
CA050079559OtherRAILROAD MEDICARE
CAZZZ20562ZOtherMEDICARE GROUP PROVIDER NUMBER