MEDICARE: DR. ROBERT JUDSON BREWER M.D.

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	208600000X	Surgery Physician	23499	KY
2	208600000X	Surgery Physician	036117928	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7210895	OTHER	IL	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3932056	OTHER	IL	BCBS
4	654532	OTHER	IL	HEALTHLINK
5	133018	OTHER	IL	HEALTH ALLIANCE
6	319226	OTHER	IL	GHP
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457355315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JUDSON BREWER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1105
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46206-1105
Country	:	US
Telephone Number	:	618-549-5361
Fax Number	:	618-549-5128

Provider Business Practice Location Address
First Line	:	220 S PARK AVE
Second Line	:	3RD FLOOR
City	:	HERRIN
State	:	IL
Zip	:	62948-3612
Country	:	US
Telephone Number	:	618-942-2002
Fax Number	:	618-351-6497

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	01/12/2015

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Directions to “ DR. ROBERT JUDSON BREWER M.D.” Practice Location

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