Healthcare Provider Details

I. General information

NPI: 1073623245
Provider Name (Legal Business Name): JEFFREY A. BROWER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 ENGINEERING DR
SPRINGFIELD IL
62703-5909
US

IV. Provider business mailing address

1121 N 6TH ST
VANDALIA IL
62471-1219
US

V. Phone/Fax

Practice location:
  • Phone: 217-522-4300
  • Fax:
Mailing address:
  • Phone: 618-283-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-082540
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: