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NPI Code Detail

MEDICARE: DR. BRIAN RICHARD BREWER PHD, LP

MEDICARE: DR. BRIAN RICHARD BREWER PHD, LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist

General Provider Information

NPI Number : 1285650572
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN RICHARD BREWER PHD, LP
Provider Business Mailing Address
First Line : 2330 SIOUX TRL NW
Second Line :
City : PRIOR LAKE
State : MN
Zip : 55372-9077
Country : US
Telephone Number : 952-496-6167
Fax Number : 952-233-4255
Provider Business Practice Location Address
First Line : 2330 SIOUX TRL NW
Second Line :
City : PRIOR LAKE
State : MN
Zip : 55372-9077
Country : US
Telephone Number : 952-496-6167
Fax Number : 952-233-4255
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 07/08/2007

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