Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 676 | SC |
N | 222Z00000X | Podiatrist | 676 | SC |
N | 213EP0504X | Public Medicine | 676 | SC |
N | 213EP1101X | Primary Podiatric Medicine | 676 | SC |
N | 111NR0200X | Radiology | 676 | SC |
N | 213ER0200X | Radiology | 676 | SC |
Y | 213ES0103X | Foot & Ankle Surgery | 676 | SC |
NPI | 1679924971 |
---|---|
Provider Name | Dr. Brandon Michael Brooks |
First Address | Sumter, SC 29150-8004 |
Second Address | Sumter, SC 29150-8004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2016 |
Last Update Date | 30/06/2020 |