Provider Demographics
NPI:1568469815
Name:BREWSTER, SCOT A (MD)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:A
Last Name:BREWSTER
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:PO BOX 514016
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-4016
Mailing Address - Country:US
Mailing Address - Phone:858-455-6330
Mailing Address - Fax:
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:STE 560
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1229
Practice Address - Country:US
Practice Address - Phone:858-455-6330
Practice Address - Fax:858-455-5408
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46084208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A460840Medicaid
CAE24908Medicare UPIN