Individual
DR. BRADLEY P BRETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2537 W STATE ST STE 200, BOISE, ID 83702-2200
(208) 336-0895
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
M8818
ID
208VP0000X
Pain Medicine Physician
M8818
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227200
—
OR
05
—
806623200
—
ID
01
—
P00036984
RAILROAD MEDICARE
ID
01
—
P00754805
RAILROAD MEDICARE
ID
Enumeration date
10/11/2005
Last updated
01/10/2018
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