Active NPI
Beaufort Dermatology PC
- Dermatology Physician
- Beaufort, SC
National Provider Identifier
1821205097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 17632
- Legal business name
- BEAUFORT DERMATOLOGY PC
- Practice address
- 1096 Ribaut Road
Beaufort, SC 29902 - Phone
- (843) 524-5550
- Fax
- (842) 524-6798
- NPI assigned
- May 17, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Paul C Brewer, MD
- Title
- Owner
- Phone
- (843) 524-5550
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 17632 | SC | Primary |
| Pediatric Dermatology Physician | 207NP0225X | 17636 | SC |
Addresses
Primary practice location
1096 Ribaut Road
Beaufort, SC 29902
Mailing address
1096 Ribaut Road
Beaufort, SC 29902
Phone (843) 524-5550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6P1193 | Medicaid | SC |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1191888000000",
"number": "1821205097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1096 RIBAUT ROAD",
"city": "BEAUFORT",
"state": "SC",
"postal_code": "29902",
"telephone_number": "843-524-5550",
"fax_number": "842-524-6798"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1096 RIBAUT ROAD",
"city": "BEAUFORT",
"state": "SC",
"postal_code": "29902",
"telephone_number": "843-524-5550",
"fax_number": "842-524-6798"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BEAUFORT DERMATOLOGY PC",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-17",
"last_updated": "2007-10-09",
"status": "A",
"authorized_official_last_name": "BREWER",
"authorized_official_first_name": "PAUL",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "843-524-5550",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dermatology",
"state": "SC",
"license": "17632",
"primary": true
},
{
"code": "207NP0225X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dermatology, Pediatric Dermatology",
"state": "SC",
"license": "17636",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6P1193",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaufort, SC
- Beaufort County Memorial Hospital
- Beaufort County Memorial Hospital (BMH Crisis Stabilization Unit)
- Beaufort County Memorial Hospital (Beaufort Memorial Emergency Medicine Physicians)
- Beaufort County Memorial Hosptial
- Beaufort County School District
- Beaufort Emergency Medicine, PA
- Beaufort ENT & Allergy LLC
- Beaufort Family Care LLC
- Beaufort Family Care, LLC
- Beaufort Family Dentistry VSM LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.