Provider Demographics
NPI:1538516778
Name:BREWER, BRETT JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:JOSEPH
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 1:590 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5228
Mailing Address - Country:US
Mailing Address - Phone:928-536-7519
Mailing Address - Fax:928-532-2139
Practice Address - Street 1:590 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5228
Practice Address - Country:US
Practice Address - Phone:928-536-7519
Practice Address - Fax:928-532-2139
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ60362208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ004693Medicaid