Basic Information
| Provider Information | |||||||||
| NPI: | 1467656942 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BREWER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | PAUL | ||||||||
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| OtherLastName: | BREWER | ||||||||
| OtherFirstName: | JAMES | ||||||||
| OtherMiddleName: | P. | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | P.O. BOX 173862 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802173862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033067783 | ||||||||
| FaxNumber: | 3033067753 | ||||||||
| Practice Location | |||||||||
| Address1: | 4567 E. 9TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802205337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033202455 | ||||||||
| FaxNumber: | 3033067753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 07/02/2015 | ||||||||
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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 | 207P00000X | MD0000045309 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 49761 | CO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | DR.0049761 | CO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00943890 | 01 | CO | RAILROAD MEDICARE | OTHER | 39322289 | 05 | CO | MEDICAID |