Provider Demographics
NPI:1346508637
Name:BREWER, STANLEY E (DO)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:E
Last Name:BREWER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 S. 7TH ST.
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4559
Mailing Address - Country:US
Mailing Address - Phone:812-234-4899
Mailing Address - Fax:812-234-6614
Practice Address - Street 1:4733 S. 7TH ST.
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4559
Practice Address - Country:US
Practice Address - Phone:812-234-4899
Practice Address - Fax:812-234-6614
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10315915-1204208000000X, 2084P0804X
IN020043772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201124800Medicaid