Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 03335 | KY |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 03335 | KY |
NPI | 1558524199 |
---|---|
Provider Name | Dr. Vernon Dwayne Brewer |
First Address | Lexington, KY 40504-3229 |
Second Address | Lexington, KY 40504-3229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2008 |
Last Update Date | 24/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100198310 | (05) | KY |