MEDICARE: KATHRYN L BREWER MD P C

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	207R00000X	Internal Medicine Physician	18020	OK

General Provider Information

NPI Number	:	1336261494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHRYN L BREWER MD P C

Provider Business Mailing Address
First Line	:	5701 N PORTLAND AVE
Second Line	:	SUITE 325
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1678
Country	:	US
Telephone Number	:	405-951-4980
Fax Number	:	405-951-4981

Provider Business Practice Location Address
First Line	:	5701 N PORTLAND AVE
Second Line	:	SUITE 325
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1678
Country	:	US
Telephone Number	:	405-951-4980
Fax Number	:	405-951-4981

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	KATHRYN BREWER
Credential	:	MD
Telephone Number	:	405-951-4980

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	10/04/2007

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