Provider Demographics
NPI:1356155675
Name:BREWER, DAMEKO
Entity type:Individual
Prefix:
First Name:DAMEKO
Middle Name:
Last Name:BREWER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17209 S 90TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-6410
Mailing Address - Country:US
Mailing Address - Phone:918-565-2568
Mailing Address - Fax:
Practice Address - Street 1:17209 S 90TH EAST AVE
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-6410
Practice Address - Country:US
Practice Address - Phone:918-565-2568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management