Provider Demographics
NPI:1174783450
Name:BREWSTER, LUKE PACKARD (MD PHD MA)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:PACKARD
Last Name:BREWSTER
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Gender:M
Credentials:MD PHD MA
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Mailing Address - Street 1:1365 CLIFTON RD NE
Mailing Address - Street 2:BLDG A--SUITE 3200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-3712
Mailing Address - Fax:404-778-3101
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:BLDG A--SUITE 3200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-3712
Practice Address - Fax:404-778-3101
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2011-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-110325208600000X
GA628202086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery