Provider Demographics
NPI:1558651356
Name:BREWER, ELIZABETH ARYN (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ARYN
Last Name:BREWER
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Gender:F
Credentials:DO
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Mailing Address - Street 1:2401 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-2726
Mailing Address - Country:US
Mailing Address - Phone:918-561-5701
Mailing Address - Fax:918-561-1173
Practice Address - Street 1:118 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4011
Practice Address - Country:US
Practice Address - Phone:918-893-3520
Practice Address - Fax:918-893-3538
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2019-11-12
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Provider Licenses
StateLicense IDTaxonomies
OK5191207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200442660BMedicaid
OK714970OtherMEDICARE