Provider Demographics
NPI:1144306572
Name:CONNOLLY, BRENDON R (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDON
Middle Name:R
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 5TH ST E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-2002
Mailing Address - Country:US
Mailing Address - Phone:941-757-3521
Mailing Address - Fax:941-714-0869
Practice Address - Street 1:530 5TH ST E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-2002
Practice Address - Country:US
Practice Address - Phone:941-757-3521
Practice Address - Fax:941-714-0869
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98137207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96779OtherBLUE CROSS BLUE SHIELD
FL278117400Medicaid
FL278117400Medicaid
FL4818310001Medicare NSC