Provider Demographics
NPI:1700870425
Name:BREWER, JOHN E (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:BREWER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 NIAGARA ST
Mailing Address - Street 2:NIAGARA FAMILY HEALTH CENTER
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-2135
Mailing Address - Country:US
Mailing Address - Phone:716-859-4110
Mailing Address - Fax:716-859-4179
Practice Address - Street 1:300 NIAGARA ST
Practice Address - Street 2:NIAGARA FAMILY HEALTH CENTER
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-2135
Practice Address - Country:US
Practice Address - Phone:716-859-4110
Practice Address - Fax:716-859-4179
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2010-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1936291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01444917Medicaid
NY01444917Medicaid
D72575Medicare UPIN