Individual
LON RUSSELL BREWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1924 NW 88TH CT, CLIVE, IA 50325-5463
(515) 237-3974
(515) 883-2692
Mailing address
2213 GRAND AVE, DES MOINES, IA 50312-5305
(515) 237-3974
(515) 883-2692
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01444
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080171037
RR MEDICARE
IA
01
—
1326095399
WELLMARK BCBS
IA
05
—
1326095399
—
IA
05
—
5084277
—
IA
Enumeration date
05/27/2006
Last updated
06/02/2014
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