Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD161920 | OR |
NPI | 1053553321 |
---|---|
Provider Name | Dr. Samuel Fritz Bremmer |
First Address | Henderson, NV 89074-7759 |
Second Address | Portland, OR 97239-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2009 |
Last Update Date | 16/04/2016 |