Healthcare Provider Details

I. General information

NPI: 1639174014
Provider Name (Legal Business Name): KENNETH CARL BREWINGTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOBILE INFIRMARY CIR
MOBILE AL
36607-3513
US

IV. Provider business mailing address

5 MOBILE INFIRMARY CIR
MOBILE AL
36607-3513
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-5708
  • Fax: 251-435-2543
Mailing address:
  • Phone: 251-435-5708
  • Fax: 251-435-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number10532
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: