Provider Demographics
NPI:1922270966
Name:BREWSTER, KURT A (MD)
Entity type:Individual
Prefix:MR
First Name:KURT
Middle Name:A
Last Name:BREWSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1737 SW HARTLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-8370
Mailing Address - Country:US
Mailing Address - Phone:541-474-1020
Mailing Address - Fax:541-474-1108
Practice Address - Street 1:1601 NE 6TH STREET
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1494
Practice Address - Country:US
Practice Address - Phone:541-474-1020
Practice Address - Fax:541-474-1108
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20661207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR154065Medicare UPIN