Provider Demographics
NPI:1013983196
Name:DREIMAN, CHESTER J (MD)
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:J
Last Name:DREIMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2562 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6804
Mailing Address - Country:US
Mailing Address - Phone:303-501-2195
Mailing Address - Fax:
Practice Address - Street 1:2562 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-6804
Practice Address - Country:US
Practice Address - Phone:303-501-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33041207R00000X
IL036164434207R00000X
NMMD2023-1656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM31088546Medicaid
OK200088620AMedicaid
KS200389280AMedicaid
CO01330414Medicaid
OK200088620AMedicaid
CO808583Medicare PIN