Provider Demographics
NPI:1639164007
Name:BREWSTER, GREGORY SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:SCOTT
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 661748
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-1748
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:111 N SEPULVEDA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6849
Practice Address - Country:US
Practice Address - Phone:310-379-2134
Practice Address - Fax:310-379-4856
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61173207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A611730Medicaid
CA00A611730Medicaid
CAWA61173HMedicare PIN
CAG88238Medicare UPIN