Healthcare Provider Details

I. General information

NPI: 1285897637
Provider Name (Legal Business Name): JENNIFER M BREY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER M BERGANT

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3999 DUTCHMANS LN SUITE 6F
LOUISVILLE KY
40207-4729
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-394-5678
  • Fax: 502-394-5600
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number44553
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: