Individual
JOHN C BREWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4500 MAIN ST, GRANT, AL 35747-8303
(256) 728-8600
Mailing address
PO BOX 10, GUNTERSVILLE, AL 35976-0010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21112
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051555311
MEDICARE PROVIDER #
—
01
—
21112
LICENSE
AL
01
—
I22926
UPIN
—
01
—
J032
MEDICARE LEGACY #
AL
Enumeration date
06/15/2006
Last updated
03/07/2023
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