Healthcare Provider Details

I. General information

NPI: 1609848316
Provider Name (Legal Business Name): DOUGLAS FRANK BREWSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10243 GENETIC CENTER DR
SAN DIEGO CA
92121-6310
US

IV. Provider business mailing address

10243 GENETIC CENTER DR
SAN DIEGO CA
92121-6310
US

V. Phone/Fax

Practice location:
  • Phone: 858-526-6136
  • Fax: 858-526-6117
Mailing address:
  • Phone: 858-526-6136
  • Fax: 858-526-6117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberG67825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: