Provider Demographics
NPI:1376712778
Name:STEPHEN L BREWBAKER, MD
Entity Type:Organization
Organization Name:STEPHEN L BREWBAKER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BREWBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-251-0062
Mailing Address - Street 1:1726 NEW HANOVER MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5344
Mailing Address - Country:US
Mailing Address - Phone:910-251-0062
Mailing Address - Fax:910-251-0220
Practice Address - Street 1:1726 NEW HANOVER MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5344
Practice Address - Country:US
Practice Address - Phone:910-251-0062
Practice Address - Fax:910-251-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26202207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2326326Medicare PIN