Provider Demographics
NPI:1679968697
Name:BREWER, JEREMIAH (DO)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:BREWER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 CARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4192
Mailing Address - Country:US
Mailing Address - Phone:817-726-6083
Mailing Address - Fax:
Practice Address - Street 1:2507 CARRINGTON DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4192
Practice Address - Country:US
Practice Address - Phone:817-726-6083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS22452084P0800X
WI18252084P0800X
AR390200000X
IL036.1626022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program