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General NPI Number Information
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NPI Number | 1457355315
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Entity Type | Individual
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Provider Name | ROBERT JUDSON BREWER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 220 S PARK AVE 3RD FLOOR
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City | HERRIN
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State | IL
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Zip | 62948-3612
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Country | US
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Telephone | 618-942-2002
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Fax | 618-351-6497
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Provider Business Mailing Address
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Address Line | PO BOX 1105
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-1105
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Country | US
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Telephone | 618-549-5361
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Fax | 618-549-5128
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 23499
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036117928
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License Number State | IL
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