Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 105058 | MO |
NPI | 1033195540 |
---|---|
Provider Name | Dr. Roxane S Bremen |
First Address | Lees Summit, MO 64063-2280 |
Second Address | Lees Summit, MO 64063-2280 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 17/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0524537 | KANSAS LICENSE (01) | KS |
1033195540 | (05) | MO |
105058 | MISSOURI LICENSE (01) | MO |
F90077 | (02) | MO |