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General NPI Number Information
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NPI Number | 1760415657
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Entity Type | Individual
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Provider Name | KENNETH R BREWER DPM
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 1708 YAKIMA AVE STE 110
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City | TACOMA
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State | WA
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Zip | 98405-5307
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Country | US
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Telephone | 253-627-9151
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Fax |
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Provider Business Mailing Address
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Address Line | 1708 YAKIMA AVE STE 110
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City | TACOMA
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State | WA
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Zip | 98405-5307
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Country | US
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Telephone | 253-627-9151
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Fax |
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO00000585
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License Number State | WA
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