Healthcare Provider Details

I. General information

NPI: 1235573114
Provider Name (Legal Business Name): ANN CHANG BREWER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 COMMONS LOOP STE 300
KALISPELL MT
59901-1904
US

IV. Provider business mailing address

1300 N HOLOPONO ST STE 215
KIHEI HI
96753-6945
US

V. Phone/Fax

Practice location:
  • Phone: 406-756-7555
  • Fax:
Mailing address:
  • Phone: 808-874-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number49545
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberR73761
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number56288
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: