Provider Demographics
NPI:1629139209
Name:BREMER, RICHARD LOUIS (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LOUIS
Last Name:BREMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:LOUIS
Other - Last Name:BREMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:20 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:AU SABLE FORKS
Mailing Address - State:NY
Mailing Address - Zip Code:12912-0666
Mailing Address - Country:US
Mailing Address - Phone:518-647-8164
Mailing Address - Fax:
Practice Address - Street 1:27 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:AU SABLE FORKS
Practice Address - State:NY
Practice Address - Zip Code:12912-0666
Practice Address - Country:US
Practice Address - Phone:518-647-8164
Practice Address - Fax:518-647-2127
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108854207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine