Provider Demographics
NPI:1760400832
Name:BREWER, ALAN W (DO)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:W
Last Name:BREWER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5210 NORTH BELT HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1211
Mailing Address - Country:US
Mailing Address - Phone:816-271-4993
Mailing Address - Fax:816-271-4916
Practice Address - Street 1:5210 NORTH BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-1211
Practice Address - Country:US
Practice Address - Phone:816-271-4992
Practice Address - Fax:816-271-4916
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO104649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO21647020OtherBLUE CROSS/BLUE SHIELD KC
MO246807846Medicaid
MO10001084400OtherCOMMUNITY HEALTH PLAN
MO26D0896653OtherCLIA
MO703716OtherBLUE CROSS/BLUE SHIELD KS
MO0855711OtherAETNA
KS100236440AMedicaid
MO26D0896653OtherCLIA
MO0855711OtherAETNA
MOE47831Medicare UPIN