Provider Demographics
NPI:1417912429
Name:BREWER, JAMES H JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:BREWER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-239-9920
Mailing Address - Fax:502-239-9936
Practice Address - Street 1:8113 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-3441
Practice Address - Country:US
Practice Address - Phone:502-239-9920
Practice Address - Fax:502-239-9936
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2019-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY17375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64173750Medicaid
KYC73709Medicare UPIN
KYP00421351Medicare PIN
KY00546081Medicare Oscar/Certification