Provider Demographics
NPI:1790969210
Name:ROBERT BREMS MD PC
Entity Type:Organization
Organization Name:ROBERT BREMS MD PC
Other - Org Name:BREMS EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BREMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-200-0770
Mailing Address - Street 1:300 E OSBORN RD
Mailing Address - Street 2:100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2347
Mailing Address - Country:US
Mailing Address - Phone:602-200-0770
Mailing Address - Fax:602-294-0363
Practice Address - Street 1:300 E OSBORN RD
Practice Address - Street 2:100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2347
Practice Address - Country:US
Practice Address - Phone:602-200-0770
Practice Address - Fax:602-294-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20722174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE58692Medicare UPIN
AZ61805Medicare PIN