Provider Demographics
NPI:1417932385
Name:BREES, ERNEST MAYTUM (PA-C)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:MAYTUM
Last Name:BREES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IA
Mailing Address - Zip Code:50060-1749
Mailing Address - Country:US
Mailing Address - Phone:641-872-1602
Mailing Address - Fax:
Practice Address - Street 1:417 S EAST ST
Practice Address - Street 2:SUITE #100
Practice Address - City:CORYDON
Practice Address - State:IA
Practice Address - Zip Code:50060-1860
Practice Address - Country:US
Practice Address - Phone:641-872-2063
Practice Address - Fax:641-872-2070
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000754363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
45499Medicare ID - Type Unspecified
IAR81010Medicare UPIN