Provider Demographics
NPI:1811190028
Name:BREHM, BRIAN DOUGLAS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DOUGLAS
Last Name:BREHM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 W FORK RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7548
Mailing Address - Country:US
Mailing Address - Phone:513-961-4335
Mailing Address - Fax:513-961-4227
Practice Address - Street 1:3747 W FORK RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7548
Practice Address - Country:US
Practice Address - Phone:513-961-4335
Practice Address - Fax:513-961-4227
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2613363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100056850Medicaid
OKP00407367OtherRAILROAD MEDICARE
OKP00407367OtherRAILROAD MEDICARE