Provider Demographics
NPI:1346597234
Name:BROWER, JERMY JOE
Entity Type:Individual
Prefix:MR
First Name:JERMY
Middle Name:JOE
Last Name:BROWER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 181513
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92178-1513
Mailing Address - Country:US
Mailing Address - Phone:602-908-9586
Mailing Address - Fax:
Practice Address - Street 1:SEAL TEAM ONE 2534 TRIDENT WAY BLDG 614
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-0001
Practice Address - Country:US
Practice Address - Phone:619-437-2564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman