Provider Demographics
NPI:1336181239
Name:BREMER, JONATHAN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SCOTT
Last Name:BREMER
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 1:1503 W ELK AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2876
Mailing Address - Country:US
Mailing Address - Phone:423-542-0400
Mailing Address - Fax:423-542-0201
Practice Address - Street 1:1503 W ELK AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2876
Practice Address - Country:US
Practice Address - Phone:423-542-0400
Practice Address - Fax:423-542-0201
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD15225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3007639Medicaid
TN4019973OtherBCBS
TN3007639Medicaid
TN4019973OtherBCBS