Provider Demographics
NPI:1962652313
Name:BREWER, CHRISTIAN DAVID (MPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:DAVID
Last Name:BREWER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 BOB WHITE RD
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-3575
Mailing Address - Country:US
Mailing Address - Phone:903-816-0680
Mailing Address - Fax:
Practice Address - Street 1:164 BOB WHITE RD
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-3575
Practice Address - Country:US
Practice Address - Phone:903-816-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1128080171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor