Healthcare Provider Details

I. General information

NPI: 1811190028
Provider Name (Legal Business Name): BRIAN DOUGLAS BREHM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3747 W FORK RD
CINCINNATI OH
45247-7548
US

IV. Provider business mailing address

3747 W FORK RD
CINCINNATI OH
45247-7548
US

V. Phone/Fax

Practice location:
  • Phone: 513-961-4335
  • Fax: 513-961-4227
Mailing address:
  • Phone: 513-961-4335
  • Fax: 513-961-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2613
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: