# BRIAN J ROBERTS MD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GRAND STAND UROLOGY LLP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225199094
- **Authorized official:** CHRIS RICHARDSON (EXEC DIR)
- **Authorized official phone:** (843) 449-1010

## Contact information

- **Practice address:** 823 82ND PKWY, MYRTLE BEACH, SC 29572-4607
- **Practice address phone:** (843) 449-1010
- **Practice address fax:** (843) 497-6171
- **Mailing address:** 823 82ND PKWY, MYRTLE BEACH, SC 29572-4607

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | 20257 | SC | Yes |

## Other

- **Enumeration date:** 12/13/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4226216 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |
| 05 | — | GP1418 | — | SC |