Individual
JAQURIS DASHUN BREWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1037 W 39TH ST, NORFOLK, VA 23508-2788
(434) 378-1126
Mailing address
218 TRAVIS DR, LAWRENCEVILLE, VA 23868-4025
(434) 532-3450
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
83-3462452
—
VA
Enumeration date
02/16/2019
Last updated
02/16/2019
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