Provider Demographics
NPI:1689209991
Name:EARL BREWSTER MD PA
Entity Type:Organization
Organization Name:EARL BREWSTER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-865-1996
Mailing Address - Street 1:101 N 8TH ST STE 1001
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3101
Mailing Address - Country:US
Mailing Address - Phone:770-865-1996
Mailing Address - Fax:407-386-7878
Practice Address - Street 1:101 N 8TH ST STE 1001
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3101
Practice Address - Country:US
Practice Address - Phone:770-865-1996
Practice Address - Fax:407-386-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty