Provider Demographics
NPI:1366628059
Name:BREWER, JUSTIN MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MITCHELL
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 1:601 SHEA CV
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6287
Mailing Address - Country:US
Mailing Address - Phone:601-829-0208
Mailing Address - Fax:
Practice Address - Street 1:601 SHEA CV
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-6287
Practice Address - Country:US
Practice Address - Phone:601-829-0208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-13
Last Update Date:2008-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-1881207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology