Individual
MR. GERALD EDWIN BRENNEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.C.
Contact information
Practice address
COATS MEDICAL CLINIC, 25 NORTH JOHNSON ST., COATS, NC 27521
(910) 897-6423
(910) 897-2540
Mailing address
P.O. BOX 819, 25 NORTH JOHNSON ST., COATS, NC 27521-0819
(910) 897-6423
(910) 897-2540
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
101469
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101469
STATE LICENSE NUMBER
NC
Enumeration date
07/05/2006
Last updated
09/26/2012
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