Healthcare Provider Details

I. General information

NPI: 1629018544
Provider Name (Legal Business Name): DAVID BROUWER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 HOSPITAL RD STE 322
NEWPORT BEACH CA
92663-3524
US

IV. Provider business mailing address

PO BOX 3088
SUISUN CITY CA
94585-6088
US

V. Phone/Fax

Practice location:
  • Phone: 949-574-0777
  • Fax: 949-650-3505
Mailing address:
  • Phone: 657-241-3600
  • Fax: 657-241-7720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG74779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: