Provider Demographics
NPI:1598010191
Name:BREWER, THOMAS LEE
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEE
Last Name:BREWER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16203 GALLOPING OAK KNL
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-3916
Mailing Address - Country:US
Mailing Address - Phone:210-291-9749
Mailing Address - Fax:210-637-9000
Practice Address - Street 1:16203 GALLOPING OAK KNL
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154
Practice Address - Country:US
Practice Address - Phone:210-291-9749
Practice Address - Fax:210-637-9000
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical