Provider Demographics
NPI:1568453710
Name:BREW, DOUGLAS S (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:S
Last Name:BREW
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 1:1520 NORTHWAY COURT
Mailing Address - Street 2:CENTRACARE CLINIC HEARTLAND
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-251-1775
Mailing Address - Fax:320-240-3131
Practice Address - Street 1:1520 NORTHWAY COURT
Practice Address - Street 2:CENTRACARE CLINIC HEARTLAND
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-251-1775
Practice Address - Fax:320-240-3131
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
337513700OtherMEDICAL ASSISTANCE
0101842OtherMEDICA HEALTH PLANS
2114055OtherFIRST HEALTH PLAN
620292OtherARAZ GRP AMERICA'S PPO
86D72BROtherBLUE CROSS BLUE SHIELD
080089973OtherRR MEDICARE
1013394OtherPREFERRED ONE
116610OtherU CARE
HP22750OtherHEALTH PARTNERS
337513700OtherMEDICAL ASSISTANCE
0101842OtherMEDICA HEALTH PLANS
1013394OtherPREFERRED ONE