Provider Demographics
NPI:1477823979
Name:BREWER, DEWELL LERONE
Entity Type:Individual
Prefix:MR
First Name:DEWELL
Middle Name:LERONE
Last Name:BREWER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 SW JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-7215
Mailing Address - Country:US
Mailing Address - Phone:580-647-7246
Mailing Address - Fax:
Practice Address - Street 1:1307 SW JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-7215
Practice Address - Country:US
Practice Address - Phone:580-647-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-31
Last Update Date:2011-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor