Healthcare Provider Details

I. General information

NPI: 1659341238
Provider Name (Legal Business Name): CHRISTOPHER BREWER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 PAUL W BRYANT DR E
TUSCALOOSA AL
35401-2055
US

IV. Provider business mailing address

PO BOX 2447
TUSCALOOSA AL
35403-2447
US

V. Phone/Fax

Practice location:
  • Phone: 205-345-0192
  • Fax: 205-247-2878
Mailing address:
  • Phone: 205-345-0192
  • Fax: 205-247-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: