Provider Demographics
NPI:1043312796
Name:BREMER, DAV WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:DAV
Middle Name:WILLIAM
Last Name:BREMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 E ALEX BELL RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE FINANCE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2687
Mailing Address - Country:US
Mailing Address - Phone:937-433-9082
Mailing Address - Fax:937-433-2994
Practice Address - Street 1:1201 E ALEX BELL RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE FINANCE
Practice Address - State:OH
Practice Address - Zip Code:45459-2687
Practice Address - Country:US
Practice Address - Phone:937-433-9082
Practice Address - Fax:937-433-2994
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH047246207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0820057OtherUNITED HEALTHCARE
OH0483641Medicaid
OH000000013969OtherANTHEM BCBS
A15070Medicare UPIN
OH1253840001Medicare NSC
OH0820057OtherUNITED HEALTHCARE