Provider Demographics
NPI:1669436028
Name:BREHM, JOHN G (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:BREHM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3001 CHESTERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1126
Mailing Address - Country:US
Mailing Address - Phone:304-346-9864
Mailing Address - Fax:304-346-9863
Practice Address - Street 1:3001 CHESTERFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1126
Practice Address - Country:US
Practice Address - Phone:304-346-9864
Practice Address - Fax:304-346-9863
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV20370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA03855Medicare UPIN