Healthcare Provider Details

I. General information

NPI: 1699106575
Provider Name (Legal Business Name): BRENDAN DURAN IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 REMOUNT RD BLDG 3107
NORTH CHARLESTON SC
29406-3516
US

IV. Provider business mailing address

4207 HOLLOW WIND WAY
SUMMERVILLE SC
29485-9319
US

V. Phone/Fax

Practice location:
  • Phone: 217-588-8156
  • Fax:
Mailing address:
  • Phone: 217-588-8156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: