Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 22064 | SC |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 22064 | SC |
NPI | 1205890555 |
---|---|
Provider Name | Brayton Robert Shirley |
First Address | Greenville, SC 29601-2842 |
Second Address | Greer, SC 29650-2456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 12/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
220647 | (05) | SC |
576007863158 | BCBS OF SC (01) | SC |
I16250 | (02) | SC |
P00699132 | RR MEDICARE (01) | SC |