Healthcare Provider Details

I. General information

NPI: 1275773046
Provider Name (Legal Business Name): MARK EDWARD BREWSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 4TH AVE NE
WATFORD CITY ND
58854-7628
US

IV. Provider business mailing address

709 4TH AVE NE
WATFORD CITY ND
58854-7628
US

V. Phone/Fax

Practice location:
  • Phone: 701-842-3000
  • Fax: 701-842-6248
Mailing address:
  • Phone: 701-842-3000
  • Fax: 701-842-6248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number20698
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: