MEDICARE: DR. MATTHEW RANDEL BREWER DDS

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
1	122300000X	Dentist	D.007221-C1	AL

General Provider Information

NPI Number	:	1316625346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW RANDEL BREWER DDS

Provider Business Mailing Address
First Line	:	831 S GAY ST
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36830-5944
Country	:	US
Telephone Number	:	804-698-0508
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 2ND AVE
Second Line	:
City	:	OPELIKA
State	:	AL
Zip	:	36801-5618
Country	:	US
Telephone Number	:	334-745-6295
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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