Provider Demographics
NPI:1467089565
Name:BREWER, PHILIP DANIEL
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:DANIEL
Last Name:BREWER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL MEDICAL CENTER, 100 BREWSTER BLVD.
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:III MARINE EXPEDITIONARY FORCE SURGEON
Practice Address - Street 2:UNIT 35605
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96382
Practice Address - Country:US
Practice Address - Phone:090-686-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
TXT2837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider