Provider Demographics
NPI:1427187848
Name:BREM, ALFRED F (DO)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:F
Last Name:BREM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 FAIRVIEW AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-5432
Mailing Address - Country:US
Mailing Address - Phone:208-459-4667
Mailing Address - Fax:208-442-6520
Practice Address - Street 1:1906 FAIRVIEW AVE STE 220
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-5432
Practice Address - Country:US
Practice Address - Phone:208-459-4667
Practice Address - Fax:208-442-6520
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-08712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269980Medicaid
OR269980Medicaid
D33622Medicare UPIN