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General NPI Number Information
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NPI Number | 1255428355
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Entity Type | Individual
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Provider Name | PETER REYNOLDS BREAM JR. MD
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Gender | Male
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 2101 W ARLINGTON BLVD STE 210
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City | GREENVILLE
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State | NC
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Zip | 27834-5758
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Country | US
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Telephone | 252-931-7638
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Fax | 252-931-7694
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Provider Business Mailing Address
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Address Line | PO BOX 30750
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City | GREENVILLE
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State | NC
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Zip | 27833-0750
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Country | US
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Telephone | 252-931-7638
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Fax | 252-931-7694
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 200001075
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 200001075
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 101363
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | MD34971
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD34971
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License Number State | TN
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Taxonomy #6
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2023049402
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License Number State | MO
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