Provider Demographics
NPI:1770681777
Name:BREWER, THOMAS J (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:BREWER
Suffix:
Gender:M
Credentials:DO
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 1688
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-1688
Mailing Address - Country:US
Mailing Address - Phone:716-634-8800
Mailing Address - Fax:716-650-9622
Practice Address - Street 1:2950 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1304
Practice Address - Country:US
Practice Address - Phone:716-634-8800
Practice Address - Fax:716-650-9622
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY231159-1207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02628339Medicaid
NYI11838Medicare UPIN
NYRB7385Medicare PIN
NYRB7384Medicare PIN