Basic Information
| Provider Information | |||||||||
| NPI: | 1538516778 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BREWER | ||||||||
| FirstName: | BRETT | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SNOWFLAKE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859375228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285367519 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 590 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SNOWFLAKE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859375228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285367519 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2016 | ||||||||
| LastUpdateDate: | 06/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 60362 | AZ | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 60362 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 004693 | 05 | AZ | MEDICAID |