Provider Demographics
NPI:1235280470
Name:HALLORAN, BRETT J (MD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:J
Last Name:HALLORAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:943S BENEVA RD 306
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2473
Mailing Address - Country:US
Mailing Address - Phone:941-362-8644
Mailing Address - Fax:941-954-4440
Practice Address - Street 1:943S BENEVA RD 306
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2473
Practice Address - Country:US
Practice Address - Phone:941-362-8644
Practice Address - Fax:941-954-4440
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036125084207R00000X
GA058417207R00000X
AZ276152207R00000X
CAC131872208M00000X, 207R00000X
FLME124342208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036125084Medicaid
IL04515143OtherBCBS#
IL036125084Medicaid
IL390362022Medicare PIN
IL390361022Medicare PIN