Healthcare Provider Details

I. General information

NPI: 1841263910
Provider Name (Legal Business Name): ANGUS MCKAY BRABHAM III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RICHLAND MEDICAL PARK SUITE 240
COLUMBIA SC
29203
US

IV. Provider business mailing address

3 RICHLAND MEDICAL PARK SUITE 240
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 803-765-1550
  • Fax: 803-771-4379
Mailing address:
  • Phone: 803-765-1550
  • Fax: 803-771-4379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number6734
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: