Provider Demographics
NPI:1306992003
Name:GERWIN, BRETT DENNIS (MD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:DENNIS
Last Name:GERWIN
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 1:979 E 3RD ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-521-2820
Mailing Address - Fax:423-602-5594
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:SUITE 230
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-521-2820
Practice Address - Fax:423-602-5594
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45994207WX0107X, 207W00000X
AL26155207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517997Medicaid
103I187899Medicare PIN