MEDICARE: DR. BRET DOUGLAS HEEREMA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083A0100X	Aerospace Medicine Physician	24360	NV
2	2083A0100X	Aerospace Medicine Physician	01059390A	IN
3	2083X0100X	Occupational Medicine Physician	01059390A	IN
4	2083X0100X	Occupational Medicine Physician	24360	NV

General Provider Information

NPI Number	:	1346239944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRET DOUGLAS HEEREMA M.D.

Provider Business Mailing Address
First Line	:	9800 W SKYE CANYON PARK DR STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-6631
Country	:	US
Telephone Number	:	702-425-5119
Fax Number	:	702-213-6079

Provider Business Practice Location Address
First Line	:	9800 W SKYE CANYON PARK DR STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-6631
Country	:	US
Telephone Number	:	702-425-5119
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	04/17/2025

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