Provider Demographics
NPI:1750384095
Name:BREWTON, GARY W (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:W
Last Name:BREWTON
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:PO BOX 9670
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79831-9670
Mailing Address - Country:US
Mailing Address - Phone:713-529-9224
Mailing Address - Fax:
Practice Address - Street 1:801 N 7TH ST
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-2901
Practice Address - Country:US
Practice Address - Phone:713-529-9224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2023-12-28
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
TXF9238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21496Medicare UPIN