Provider Demographics
NPI:1437116613
Name:BREWER, DOUGLAS C (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:C
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 1:1704 GLENDALE DR SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4415
Mailing Address - Country:US
Mailing Address - Phone:252-237-5000
Mailing Address - Fax:
Practice Address - Street 1:1704 GLENDALE DR SW
Practice Address - Street 2:SUITE B
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4415
Practice Address - Country:US
Practice Address - Phone:252-237-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-30
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC202144Medicare ID - Type UnspecifiedPROVIDER NUMBER