MEDICARE: JACOB HURLAN BRAZEE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	51275	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51275	OTHER	SC	SC MEDICAL BOARD

General Provider Information

NPI Number	:	1043630387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB HURLAN BRAZEE MD

Provider Business Mailing Address
First Line	:	PO BOX 421718
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29442-4203
Country	:	US
Telephone Number	:	843-652-8226
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 DICK POND RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6807
Country	:	US
Telephone Number	:	843-652-8100
Fax Number	:	843-652-8122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2014
Last Update Date	:	09/30/2025

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