Provider Demographics
NPI:1013910264
Name:BRENNAN, CYNTHIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:M
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:M
Other - Last Name:HOUDESHELDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9100 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4417
Mailing Address - Country:US
Mailing Address - Phone:405-840-4456
Mailing Address - Fax:405-840-4295
Practice Address - Street 1:9100 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4417
Practice Address - Country:US
Practice Address - Phone:405-840-4456
Practice Address - Fax:405-840-4295
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-11-10
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
AZAZ 19008207Q00000X
OK14390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200130090AMedicaid
AZ289638Medicaid
AZE28680Medicare UPIN
AZ289638Medicaid
AZMD19008Medicare ID - Type Unspecified