Individual
MR. JUSTIN MICHAEL BREWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MMS, ATC, PA-C
Contact information
Practice address
527 MEDICAL PARK DR STE 400, BRIDGEPORT, WV 26330-9010
(681) 342-3500
(681) 342-3507
Mailing address
527 MEDICAL PARK DR STE 400, BRIDGEPORT, WV 26330-9010
(681) 342-3500
(681) 342-3507
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0110003033
VA
363AS0400X
Surgical Physician Assistant
Primary
01518
WV
363AS0400X
Surgical Physician Assistant
513
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA37501
MEDICARE PTAN
WV
Enumeration date
06/16/2009
Last updated
05/08/2014
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