Provider Demographics
NPI:1699885624
Name:BRAHM, STEPHEN MARSMAN (DPM)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARSMAN
Last Name:BRAHM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 ST. JOHN PLACE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4435
Mailing Address - Country:US
Mailing Address - Phone:951-658-2159
Mailing Address - Fax:951-658-8372
Practice Address - Street 1:995 ST. JOHN PL
Practice Address - Street 2:SUITE B
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4435
Practice Address - Country:US
Practice Address - Phone:951-658-2159
Practice Address - Fax:951-658-8372
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE29830213EP1101X
CAE29380213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E29380Medicaid
CA33-0006705OtherTAX ID NUMBER
CA000E29380Medicaid
CAT11521Medicare UPIN