Provider Demographics
NPI:1346234028
Name:BREMER, JOYCE F (MD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:F
Last Name:BREMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N OAK AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2435
Mailing Address - Country:US
Mailing Address - Phone:931-783-5857
Mailing Address - Fax:931-526-6760
Practice Address - Street 1:438 N WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2455
Practice Address - Country:US
Practice Address - Phone:931-783-2616
Practice Address - Fax:931-783-2610
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13543207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1511160Medicaid
TN4204695OtherBCBS
KY64795693Medicaid
TN30016491Medicare PIN
TN4204695OtherBCBS
TNA96715Medicare UPIN
TN3723270Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER