Provider Demographics
NPI:1194727651
Name:BREWER, DOUGLAS ALAN (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALAN
Last Name:BREWER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3490
Mailing Address - Country:US
Mailing Address - Phone:478-301-4111
Mailing Address - Fax:
Practice Address - Street 1:250 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3490
Practice Address - Country:US
Practice Address - Phone:478-301-4111
Practice Address - Fax:478-301-5812
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2023-07-11
Deactivation Date:2006-04-10
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
GA038696208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA155965XXOtherPREFERRED CARE PPO
GA478162OtherFEP/FEDERAL BCBS
GA00622916AMedicaid
GA478162OtherBCBS
GA582243876OtherSOUTHCARE
GAE01410OtherSECURE HEALTH
GA4552736OtherAETNA
GA282025OtherPHCS
GA582243876OtherPRONET
GAP00100286OtherRR/MEDICARE
GA00622916AMedicaid
GA28BBBBJMedicare ID - Type Unspecified