Individual
RANDALL G BREWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
PMG ATRISCO, 3901 ATRISCO NW, ALBUQUERQUE, NM 87120
(505) 462-7575
(505) 462-7555
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
PA-6818
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95375
—
NM
Enumeration date
10/03/2006
Last updated
08/19/2008
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