Provider Demographics
NPI:1225102726
Name:BREWER, KEITH FREDERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:FREDERIC
Last Name:BREWER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 PICASSO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-0557
Mailing Address - Country:US
Mailing Address - Phone:530-756-1199
Mailing Address - Fax:530-758-9181
Practice Address - Street 1:1736 PICASSO AVE STE A
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-0557
Practice Address - Country:US
Practice Address - Phone:530-756-1199
Practice Address - Fax:530-758-9181
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54821208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52801Medicare UPIN