Provider Demographics
NPI:1922397710
Name:DONEGAN, BRETT TYLER (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:TYLER
Last Name:DONEGAN
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 1:1840 MEDICAL CENTER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3237
Mailing Address - Country:US
Mailing Address - Phone:615-849-7490
Mailing Address - Fax:615-890-7838
Practice Address - Street 1:1840 MEDICAL CENTER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3237
Practice Address - Country:US
Practice Address - Phone:615-849-7490
Practice Address - Fax:615-890-7838
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170096052085N0700X
AL387282085N0700X, 2085R0202X, 2085R0204X
TN634612085N0700X, 2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL14543732OtherCAQH
AL51234950OtherBCBS
AL240296Medicaid
AL240419Medicaid
AL51234991OtherBCBS
AL241692Medicaid
AL51235122OtherBCBS
AL51234994OtherBCBS
AL51235105OtherBCBS
AL240300Medicaid
AL243980Medicaid
AL51235106OtherBCBS
AL244014Medicaid
AL51234990OtherBCBS
AL51234992OtherBCBS
AL51234993OtherBCBS
AL51234995OtherBCBS