Provider Demographics
NPI:1891800892
Name:MALCOLM H. BREMER, M.D., P.A.
Entity Type:Organization
Organization Name:MALCOLM H. BREMER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:H
Authorized Official - Last Name:BREMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-446-6464
Mailing Address - Street 1:18955 N MEMORIAL DR STE 550
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4269
Mailing Address - Country:US
Mailing Address - Phone:281-446-6464
Mailing Address - Fax:281-446-7869
Practice Address - Street 1:18955 N MEMORIAL DR STE 550
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4269
Practice Address - Country:US
Practice Address - Phone:281-446-6464
Practice Address - Fax:281-446-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE50102086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX061900224OtherRAILROAD MEDICARE
TX156055901Medicaid
TX10015423OtherAMERIGROUP
TX74066451 77338 A001OtherTRICARE
TX133933503Medicaid
TXOA6039Medicare PIN