Brian J Roberts MD

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

20257 Issued in SC

Legal business name

BRIAN J ROBERTS MD

Practice address

823 82ND Pkwy
Myrtle Beach, SC 29572-4607

Phone

(843) 449-1010

Fax

(843) 497-6171

NPI assigned

Dec 13, 2006

Organization subpart

No

Name

Chris Richardson

Title

Exec Dir

Phone

(843) 449-1010

• GRAND STAND UROLOGY LLP Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1418",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4226216",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRAND STAND UROLOGY LLP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Myrtle Beach, SC
• 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.