Basic Information
| Provider Information | |||||||||
| NPI: | 1013229731 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BREWER | ||||||||
| FirstName: | BOBBY | ||||||||
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| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 ROCKWOOD LN | ||||||||
| Address2: | |||||||||
| City: | HAZARD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 417019415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064365761 | ||||||||
| FaxNumber: | 6064365797 | ||||||||
| Practice Location | |||||||||
| Address1: | 3838 HWY 15 S | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066667591 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2010 | ||||||||
| LastUpdateDate: | 07/10/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.