Healthcare Provider Details

I. General information

NPI: 1467089565
Provider Name (Legal Business Name): PHILIP DANIEL BREWER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

III MARINE EXPEDITIONARY FORCE SURGEON UNIT 35605
FPO AP
96382
US

IV. Provider business mailing address

NAVAL MEDICAL CENTER, 100 BREWSTER BLVD.
CAMP LEJEUNE NC
28547
US

V. Phone/Fax

Practice location:
  • Phone: 90-686-1760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT2837
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: