Healthcare Provider Details

I. General information

NPI: 1710030226
Provider Name (Legal Business Name): HEIDI A BREWER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 FRENCH ST
BANGOR ME
04401-5064
US

IV. Provider business mailing address

205 FRENCH ST
BANGOR ME
04401-5064
US

V. Phone/Fax

Practice location:
  • Phone: 207-945-5554
  • Fax: 207-945-5196
Mailing address:
  • Phone: 207-945-5554
  • Fax: 207-945-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPOD1032
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPOD1032
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: