Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6301009090 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301009090 | MI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301009090 | MI |
N | 103TF0200X | Forensic Psychologist | 6301009090 | MI |
NPI | 1033323563 |
---|---|
Provider Name | Dr. Thomas Gerald Brewer |
First Address | Ann Arbor, MI 48103-9794 |
Second Address | Ann Arbor, MI 48103-9794 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 25/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
680H1480600 | BLUE CROSS BLUE SHIELD NO (01) | MI |