Provider Demographics
NPI:1629089974
Name:BREHMER, JASON DANIEL (DO)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DANIEL
Last Name:BREHMER
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 1:801 COLONIAL CIR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:IA
Mailing Address - Zip Code:50211-9626
Mailing Address - Country:US
Mailing Address - Phone:515-285-3200
Mailing Address - Fax:515-285-3232
Practice Address - Street 1:801 COLONIAL CIR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:IA
Practice Address - Zip Code:50211-9626
Practice Address - Country:US
Practice Address - Phone:515-285-3200
Practice Address - Fax:515-285-3232
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR7881207Q00000X
IA3813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1629089974Medicaid
IA1629089974Medicaid
IA719260406Medicare PIN
RES0000Medicare UPIN