Provider Demographics
NPI:1710030226
Name:BREWER, HEIDI A (DPM)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:A
Last Name:BREWER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 FRENCH ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5064
Mailing Address - Country:US
Mailing Address - Phone:207-945-5554
Mailing Address - Fax:207-945-5196
Practice Address - Street 1:205 FRENCH ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5064
Practice Address - Country:US
Practice Address - Phone:207-945-5554
Practice Address - Fax:207-945-5196
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD1032213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME222840000Medicaid
ME010362456OtherFED TAX I D NUMBER
ME010362456OtherFED TAX I D NUMBER
ME222840000Medicaid
MEMM8653Medicare ID - Type Unspecified