Provider Demographics
NPI:1316258627
Name:BRENNAN, TODD J (DPM)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:J
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
Mailing Address - Street 2:SUITE205
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3946
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
Practice Address - Street 2:SUITE 205
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3946
Practice Address - Country:US
Practice Address - Phone:813-971-4678
Practice Address - Fax:813-978-8564
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3584213E00000X, 213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008391200Medicaid
FLDD7044OtherRAILROAD MEDICARE GROUP NUMBER
FLM2475OtherMEDICARE GROUP PTAN
FLM2485OtherMEDICARE PTAN
FLPO3584OtherMEDICAL LICENSE
FLM2487OtherMEDICARE PTAN
FLM2469OtherMEDICARE GROUP PTAN