Provider Demographics
NPI:1427045707
Name:BREWER, HERBERT MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:MARTIN
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 1:205 MEDICAL TOWER
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1970
Mailing Address - Country:US
Mailing Address - Phone:757-622-6601
Mailing Address - Fax:757-622-8029
Practice Address - Street 1:205 MEDICAL TOWER
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1970
Practice Address - Country:US
Practice Address - Phone:757-622-6601
Practice Address - Fax:757-622-8029
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101014387207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8905203Medicaid
VA051527OtherANTHEM
VA6029566Medicaid
VA051527OtherANTHEM