Healthcare Provider Details

I. General information

NPI: 1508809708
Provider Name (Legal Business Name): KENNETH WILLARD BREWSTER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 AVE GENERAL VALERO
FAJARDO PR
00738-4844
US

IV. Provider business mailing address

462 PASEO HERMOSO
CANOVANAS PR
00729-9891
US

V. Phone/Fax

Practice location:
  • Phone: 787-655-0459
  • Fax: 754-206-8506
Mailing address:
  • Phone: 787-948-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16048
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: