Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 21589 | SC |
NPI | 1003856352 |
---|---|
Provider Name | Peter K Brady |
First Address | Charlotte, NC 28260-1495 |
Second Address | Moncks Corner, SC 29461-2904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 19/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
215895 | (05) | SC |
F40706 | (02) |