Provider Demographics
NPI:1962577866
Name:BRENNAN, DENNIS MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:MICHAEL
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870A HIGHWAY 36 W
Mailing Address - Street 2:
Mailing Address - City:RISING STAR
Mailing Address - State:TX
Mailing Address - Zip Code:76471-3454
Mailing Address - Country:US
Mailing Address - Phone:254-643-3235
Mailing Address - Fax:325-643-3233
Practice Address - Street 1:1870A HIGHWAY 36 W
Practice Address - Street 2:
Practice Address - City:RISING STAR
Practice Address - State:TX
Practice Address - Zip Code:76471-3454
Practice Address - Country:US
Practice Address - Phone:254-643-3235
Practice Address - Fax:254-643-3233
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03746363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03746OtherLICENSE NUMBER
TXOTH000Medicare UPIN