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Organization
BRIAN J ROBERTS MD
Active
Organization
BRIAN J ROBERTS MD
Active
Other names
GRAND STAND UROLOGY LLP
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS RICHARDSON (EXEC DIR)
(843) 449-1010
Entity
Organization
Contact information
Practice address
823 82ND PKWY, MYRTLE BEACH, SC 29572-4607
(843) 449-1010
(843) 497-6171
Mailing address
823 82ND PKWY, MYRTLE BEACH, SC 29572-4607
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
20257
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4226216
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
GP1418
—
SC
Enumeration date
12/13/2006
Last updated
08/22/2020
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