Provider Demographics
NPI:1346239944
Name:HEEREMA, BRET DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRET
Middle Name:DOUGLAS
Last Name:HEEREMA
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 1:4700 LAS VEGAS BLVD N
Mailing Address - Street 2:
Mailing Address - City:NELLIS AFB
Mailing Address - State:NV
Mailing Address - Zip Code:89191-6600
Mailing Address - Country:US
Mailing Address - Phone:702-653-2273
Mailing Address - Fax:702-653-3398
Practice Address - Street 1:4700 LAS VEGAS BLVD N
Practice Address - Street 2:ATTN: CREDENTIALS OFFICE
Practice Address - City:NELLIS AFB
Practice Address - State:NV
Practice Address - Zip Code:89191-6601
Practice Address - Country:US
Practice Address - Phone:702-653-3067
Practice Address - Fax:702-653-3398
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV243602083A0100X, 2083X0100X
IN01059390A2083X0100X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine