Basic Information
| Provider Information | |||||||||
| NPI: | 1568453710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BREW | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1520 NORTHWAY COURT | ||||||||
| Address2: | CENTRACARE CLINIC HEARTLAND | ||||||||
| City: | ST CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202511775 | ||||||||
| FaxNumber: | 3202403131 | ||||||||
| Practice Location | |||||||||
| Address1: | 1520 NORTHWAY COURT | ||||||||
| Address2: | CENTRACARE CLINIC HEARTLAND | ||||||||
| City: | ST CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202511775 | ||||||||
| FaxNumber: | 3202403131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 11/22/2011 | ||||||||
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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 | 39617 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 337513700 | 01 | MEDICAL ASSISTANCE | OTHER | 0101842 | 01 | MEDICA HEALTH PLANS | OTHER | 2114055 | 01 | FIRST HEALTH PLAN | OTHER | 620292 | 01 | ARAZ GRP AMERICA'S PPO | OTHER | 86D72BR | 01 | BLUE CROSS BLUE SHIELD | OTHER | 080089973 | 01 | RR MEDICARE | OTHER | 1013394 | 01 | PREFERRED ONE | OTHER | 116610 | 01 | U CARE | OTHER | HP22750 | 01 | HEALTH PARTNERS | OTHER |