Individual
BRUCE HOWARD BRENNAMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
920 18TH ST, COLUMBUS, GA 31901-1524
(706) 649-6600
(706) 649-6614
Mailing address
PO BOX 1038, COLUMBUS, GA 31902-1038
(706) 660-6148
(706) 660-2843
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
31709
GA
2086S0129X
Vascular Surgery Physician
Primary
31709
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000318117B
—
GA
01
—
000318117G
MEDICAID-OFFICE
GA
05
—
008902960
—
AL
01
—
154485
MEDICAID-OFFICE
AL
01
—
52244152-005
BCBSGA
GA
01
—
600-37660
BCBSAL
AL
Enumeration date
02/03/2006
Last updated
07/01/2014
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