1336431410 NPI number — MR. STEPHEN WALTER BREWTON ATP

Table of content: MR. STEPHEN WALTER BREWTON ATP (NPI 1336431410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336431410 NPI number — MR. STEPHEN WALTER BREWTON ATP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BREWTON
Provider First Name:
STEPHEN
Provider Middle Name:
WALTER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ATP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336431410
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1517 W NORTH CARRIER PKWY
Provider Second Line Business Mailing Address:
SUITE110
Provider Business Mailing Address City Name:
GRAND PRAIRIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75050-1288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-206-7345
Provider Business Mailing Address Fax Number:
972-522-0103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1517 W NORTH CARRIER PKWY
Provider Second Line Business Practice Location Address:
SUITE110
Provider Business Practice Location Address City Name:
GRAND PRAIRIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75050-1288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-206-7345
Provider Business Practice Location Address Fax Number:
972-522-0103
Provider Enumeration Date:
05/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 247200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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