Individual
JASON D BREWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2829
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
2013022984
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851731962
—
MO
01
—
431560263
TRICARE
MO
01
—
P01241115
RR MCR
MO
Enumeration date
07/03/2013
Last updated
01/28/2014
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