Provider Demographics
NPI:1104993534
Name:BREMER, MARTIN L (DO)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:L
Last Name:BREMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 TAME TURKEY RD.
Mailing Address - Street 2:P.O. BOX 38
Mailing Address - City:LAKEMONT
Mailing Address - State:GA
Mailing Address - Zip Code:30552
Mailing Address - Country:US
Mailing Address - Phone:770-538-0910
Mailing Address - Fax:770-538-0910
Practice Address - Street 1:1296 SIMS STREET
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-534-1856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023910207L00000X
TXG6820207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE18065Medicare UPIN