Provider Demographics
NPI:1235373234
Name:JOHN CHRISTOPHER BREWER
Entity Type:Organization
Organization Name:JOHN CHRISTOPHER BREWER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-891-5102
Mailing Address - Street 1:1113 OBRIG AVE
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-1421
Mailing Address - Country:US
Mailing Address - Phone:256-891-5102
Mailing Address - Fax:256-891-5103
Practice Address - Street 1:11491 US HIGHWAY 431
Practice Address - Street 2:STE. D
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-0136
Practice Address - Country:US
Practice Address - Phone:256-891-5102
Practice Address - Fax:256-891-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00021112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI22926Medicare UPIN