Provider Demographics
NPI:1245218981
Name:BREMER, RICHARD L II (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:BREMER
Suffix:II
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:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37605-0779
Mailing Address - Country:US
Mailing Address - Phone:423-928-1145
Mailing Address - Fax:423-928-1353
Practice Address - Street 1:211 BLOUNT AVE
Practice Address - Street 2:SUITE 507
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920
Practice Address - Country:US
Practice Address - Phone:865-525-0598
Practice Address - Fax:865-525-0598
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38506208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3894138Medicaid
TN64099864Medicaid
TN7574239OtherAETNA
TN4084881OtherBLUECROSS
TN3894138Medicare ID - Type UnspecifiedMEDICARE #
H41529Medicare UPIN