Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 5405 | KY |
NPI | 1538121751 |
---|---|
Provider Name | Dr. Bruce Bradford Brehm |
First Address | Fort Sam Houston, TX 78234-6230 |
Second Address | Fort Sam Houston, TX 78234-6230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 08/07/2007 |