Healthcare Provider Details

I. General information

NPI: 1528228848
Provider Name (Legal Business Name): MATTHEW S BREMMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16850 SE 272ND ST STE 200
COVINGTON WA
98042-8492
US

IV. Provider business mailing address

PO BOX 50010
RENTON WA
98058-5010
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3581
  • Fax: 425-690-9181
Mailing address:
  • Phone: 425-228-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD60342793
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD445355
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: