Provider Demographics
NPI:1205926623
Name:BREMS, ROBERT NETTLESHIP (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:NETTLESHIP
Last Name:BREMS
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 1:300 E OSBORN RD
Mailing Address - Street 2:100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012
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
Practice Address - Country:US
Practice Address - Phone:602-200-0770
Practice Address - Fax:602-294-0363
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20722207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
61806Medicare ID - Type Unspecified
E58692Medicare UPIN