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General NPI Number Information
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NPI Number | 1528429172
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Entity Type | Individual
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Provider Name | BRETT BEMIS
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Gender | Male
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 1717 ARLINGTON AVE
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City | CALDWELL
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State | ID
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Zip | 83605-4802
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Country | US
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Telephone | 208-459-4641
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Fax |
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Provider Business Mailing Address
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Address Line | 3825 N. RAMSEY RD. APT 1204
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City | COEUR D'ALENE
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State | ID
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Zip | 83815
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Country | US
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Telephone | 208-964-9075
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-1360
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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