Healthcare Provider Details

I. General information

NPI: 1689638165
Provider Name (Legal Business Name): ALFREDO JORGE BRAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 RICHMOND AVE
PORT ROYAL SC
29935-2014
US

IV. Provider business mailing address

PO BOX 2330
BLUFFTON SC
29910-2330
US

V. Phone/Fax

Practice location:
  • Phone: 843-837-4400
  • Fax: 843-837-4440
Mailing address:
  • Phone: 843-837-4400
  • Fax: 843-837-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number15685
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: