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General NPI Number Information
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NPI Number | 1871834507
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Entity Type | Organization
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Legal Business Name | COASTAL CAROLINA MOBILE PHYSICIANS
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 1272 CROOKED OAK DR
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City | PAWLEYS ISLAND
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State | SC
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Zip | 29585-8076
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Country | US
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Telephone | 843-344-1040
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Fax | 843-237-9822
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Provider Business Mailing Address
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Address Line | 1272 CROOKED OAK DR
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City | PAWLEYS ISLAND
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State | SC
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Zip | 29585-8076
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Country | US
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Telephone | 843-344-1040
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Fax | 843-237-9822
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD SCOTT BRUMFIELD
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Credential | MD
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Telephone | 843-344-1040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25249
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License Number State | SC
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