Healthcare Provider Details

I. General information

NPI: 1821253857
Provider Name (Legal Business Name): DEAN MARK BREWER JR. D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 E MAIN ST
SPRINGVILLE NY
14141-1497
US

IV. Provider business mailing address

400 N MAIN ST
WARSAW NY
14569-1025
US

V. Phone/Fax

Practice location:
  • Phone: 716-592-2871
  • Fax:
Mailing address:
  • Phone: 585-492-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number297539
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: