Healthcare Provider Details

I. General information

NPI: 1174514079
Provider Name (Legal Business Name): REBECCA B BREWER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date: 09/25/2019
Reactivation Date: 10/14/2019

III. Provider practice location address

3925 HAGAN ST SUITE 104
BLOOMINGTON IN
47401-8556
US

IV. Provider business mailing address

3925 HAGAN ST SUITE 104
BLOOMINGTON IN
47401-8556
US

V. Phone/Fax

Practice location:
  • Phone: 812-334-8400
  • Fax: 812-334-8401
Mailing address:
  • Phone: 812-334-8400
  • Fax: 812-334-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01040663A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: