Larry A Brewer PA

NPI 1750498721 - Physician Assistant - 363A00000X

NPI Details
NPI 1750498721
Gender Male
Enumeration Date 08/24/2006
Last Updated 08/23/2011
Entity Type Individual
Active Over 10 years ago
Practice Location
550 CHERRY ST S.E.
BOB LACKEY
GRAND RAPIDS MI, 49503-2560, US
Phone (616) 776-2124
Fax
Business Location
100 MICHIGAN ST NE
BOB LACKEY
GRAND RAPIDS MI, 49503-2560, US
Phone (616) 776-2124
Fax
Toxanomy
Taxonomy Code 363A00000X
License State Michigan
License Number 5601001187
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According to our database, Mr. Larry A Brewer PA NPI is 1750498721, taxonomy code is 363A00000X and license number is 5601001187, license state is located at Michigan. Larry A Brewer PA physically located at 550 Cherry St S.e., Grand Rapids MI, 49503-2560. NPI Number Larry A Brewer PA has the Individual type.

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1750498721 NPI number is provided on an as is basis without warranty of any kind. 1750498721 is maintained by the National Plan & Provider Enumeration System. The contents of Larry A Brewer PA are for informational purposes only.