Provider Demographics
NPI:1568588168
Name:JUDSON L BREWER MD PC
Entity Type:Organization
Organization Name:JUDSON L BREWER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-323-0406
Mailing Address - Street 1:717 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2319
Mailing Address - Country:US
Mailing Address - Phone:812-323-0406
Mailing Address - Fax:
Practice Address - Street 1:717 W 1ST ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2319
Practice Address - Country:US
Practice Address - Phone:812-323-0406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00016717OtherTRAVELERS MEDICARE
IN000000176207OtherANTHEM BS
INP00016717OtherTRAVELERS MEDICARE