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Gary Brewer

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NPI Number Detailed Information

Provider Information:

Name: Gary Brewer
Gender: M
Provider License Number If Given: R021761

NPI Information:

NPI: 1427042944
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 7/8/2007

Provider Business Mailing Address:

Address: 623 WESTWIND DR
Rapid City, SD 57702
Phone Number: 6053435279
Fax Number:

Provider Business Practice Location Address:

Address: 216 ANAMARIA DR
Rapid City, SD 57701
Phone Number: 6057210337
Fax Number: 6057210043

Provider Taxonomy:

Primary: 367500000X
Secondary (if any):
State: SD