Provider Demographics
NPI:1467493742
Name:BREMNER, RICHARD L (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:BREMNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2101 KIMBALL AVE
Mailing Address - Street 2:LL14
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5063
Mailing Address - Country:US
Mailing Address - Phone:319-272-1590
Mailing Address - Fax:319-272-1535
Practice Address - Street 1:226 BLUE BELL ROAD
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-0000
Practice Address - Country:US
Practice Address - Phone:319-575-5800
Practice Address - Fax:319-575-5855
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA544213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1084772Medicaid
IA1084772Medicaid
IA44085Medicare PIN