Provider Demographics
NPI:1952320772
Name:BREWER, ROBERT ALLEN (M D)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:BREWER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 W 296TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46050-9301
Mailing Address - Country:US
Mailing Address - Phone:317-758-4266
Mailing Address - Fax:
Practice Address - Street 1:3415 W 296TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLIN
Practice Address - State:IN
Practice Address - Zip Code:46050-9301
Practice Address - Country:US
Practice Address - Phone:317-758-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01017401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC24400Medicare UPIN