Provider Demographics
NPI:1508809708
Name:BREWSTER, KENNETH WILLARD III (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WILLARD
Last Name:BREWSTER
Suffix:III
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:CARR 718 KM 2.2 BO. PASTO SECTOR PLAYITA
Mailing Address - Street 2:P. O. BOX 536
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:787-735-0624
Mailing Address - Fax:
Practice Address - Street 1:PLAZA DEL CARMEN MALL # 24 CARR 172
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-286-6060
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16048208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR16048OtherMEDICAL LICENSE