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General NPI Number Information
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NPI Number | 1346239944
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Entity Type | Individual
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Provider Name | BRET DOUGLAS HEEREMA M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 9800 W SKYE CANYON PARK DR STE 170
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City | LAS VEGAS
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State | NV
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Zip | 89166-6631
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Country | US
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Telephone | 702-425-5119
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Fax |
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Provider Business Mailing Address
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Address Line | 9800 W SKYE CANYON PARK DR STE 170
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City | LAS VEGAS
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State | NV
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Zip | 89166-6631
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Country | US
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Telephone | 702-425-5119
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Fax | 702-213-6079
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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 | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | 24360
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | 01059390A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 01059390A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 24360
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License Number State | NV
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