Healthcare Provider Details

I. General information

NPI: 1740671650
Provider Name (Legal Business Name): BRIAN JAMES MONROE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 PINE PLANTATION PKWY
OAK ISLAND NC
28461-0119
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 910-454-4032
  • Fax: 910-454-4033
Mailing address:
  • Phone: 910-754-4441
  • Fax: 910-754-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-05635
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: