Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 26470 | IA |
N | 207V00000X | Obstetrician & Gynecologist | 61454 | WI |
NPI | 1003857657 |
---|---|
Provider Name | Dr. Randall J Bremner |
First Address | Decorah, IA 52101-2325 |
Second Address | Decorah, IA 52101-2325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 28/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A03616 | (02) | IA |