Basic Information
| Provider Information | |||||||||
| NPI: | 1558350819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BREWNER | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 S CASCADE AVE | ||||||||
| Address2: | 140 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809031624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195382950 | ||||||||
| FaxNumber: | 7195382996 | ||||||||
| Practice Location | |||||||||
| Address1: | 1770 DEER CREEK RD | ||||||||
| Address2: | |||||||||
| City: | MONUMENT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801329088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194882244 | ||||||||
| FaxNumber: | 7194811620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 08/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 33601 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01336015 | 05 | CO | MEDICAID |