Brian J Roberts MD

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

20257 Issued in SC

Legal business name

BRIAN J ROBERTS MD

Doing business as

Grand Stand Urology LLP

Practice address

823 82ND Pkwy
Myrtle Beach, SC 29572-4607

Phone

(843) 449-1010

Fax

(843) 497-6171

NPI assigned

Dec 13, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chris Richardson

Title

Exec Dir

Phone

(843) 449-1010

Specialties & licenses 1

Addresses

Other names 1

• GRAND STAND UROLOGY LLP Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225199094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 82ND PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "823 82ND PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724607",
            "telephone_number": "843-449-1010",
            "fax_number": "843-497-6171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN J ROBERTS MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "EXEC DIR",
        "authorized_official_telephone_number": "843-449-1010"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "SC",
            "license": "20257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRAND STAND UROLOGY LLP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Non-Pharmacy Dispensing Site in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Non-Pharmacy Dispensing Site in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.