Provider Demographics
NPI:1831170372
Name:BREMYER, JOHN W (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:BREMYER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:481 WEST PERRY ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-4115
Mailing Address - Country:US
Mailing Address - Phone:419-447-9685
Mailing Address - Fax:419-447-8900
Practice Address - Street 1:481 WEST PERRY ST
Practice Address - Street 2:SUITE D
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-4115
Practice Address - Country:US
Practice Address - Phone:419-447-9685
Practice Address - Fax:419-447-8900
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH36002545213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2010924Medicaid
OH2010924Medicaid
OH0704081Medicare PIN