Provider Demographics
NPI:1851705529
Name:BRENNAN, BRET (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRET
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13801 BRUCE B DOWNS BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3937
Mailing Address - Country:US
Mailing Address - Phone:813-971-4678
Mailing Address - Fax:813-482-0036
Practice Address - Street 1:13801 BRUCE B DOWNS BLVD STE 205
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3937
Practice Address - Country:US
Practice Address - Phone:813-971-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3868213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020597200Medicaid
FLM2503OtherMEDICARE PTAN
FLPO3868OtherLICENSE NUMBER
FL1851705529OtherNPI INDIVIDUAL
FLM2469OtherMEDICARE GROUP PTAN
FL3650ZOtherBCBS INDIVIDUAL
FLM2504OtherMEDICARE PTAN
FLM2475OtherMEDICARE GROUP PTAN
FLM2475OtherMEDICARE GROUP PTAN