MEDICARE: DR. ZACHARY EDGAR BREWER MD

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	16965	NV
2	390200000X	Student in an Organized Health Care Education/Training Program
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	A121994	CA

General Provider Information

NPI Number	:	1467741975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZACHARY EDGAR BREWER MD

Provider Business Mailing Address
First Line	:	3400 DATA DR
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1541 FLORIDA AVE STE 305
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95350-4439
Country	:	US
Telephone Number	:	209-575-5833
Fax Number	:	209-575-5836

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

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	04/04/2024

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