Provider Demographics
NPI:1558524199
Name:BREWER, VERNON DWAYNE (DO)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:DWAYNE
Last Name:BREWER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:103 ALYCIA DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2368
Mailing Address - Country:US
Mailing Address - Phone:859-624-6515
Mailing Address - Fax:859-624-6514
Practice Address - Street 1:103 ALYCIA DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2368
Practice Address - Country:US
Practice Address - Phone:859-624-6515
Practice Address - Fax:859-624-6514
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY03335207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100198310Medicaid
KYK023552Medicare PIN