Basic Information
| Provider Information | |||||||||
| NPI: | 1467493742 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BREMNER | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 KIMBALL AVE | ||||||||
| Address2: | LL14 | ||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507025063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192721590 | ||||||||
| FaxNumber: | 3192721535 | ||||||||
| Practice Location | |||||||||
| Address1: | 226 BLUE BELL ROAD | ||||||||
| Address2: | |||||||||
| City: | CEDAR FALLS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 506130000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3195755800 | ||||||||
| FaxNumber: | 3195755855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 544 | IA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 1084772 | 05 | IA | MEDICAID |