Basic Information
| Provider Information | |||||||||
| NPI: | 1235280470 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALLORAN | ||||||||
| FirstName: | BRETT | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 943S BENEVA RD 306 | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342322473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413628644 | ||||||||
| FaxNumber: | 9419544440 | ||||||||
| Practice Location | |||||||||
| Address1: | 943S BENEVA RD 306 | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342322473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413628644 | ||||||||
| FaxNumber: | 9419544440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2007 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 058417 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 036125084 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | C131872 | CA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | ME124342 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 276152 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036125084 | 05 | IL | MEDICAID | 04515143 | 01 | IL | BCBS# | OTHER |