Individual
DR. JUSTIN GERARD BROTHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
210 VILLAGE CENTER BLVD, SUITE 200, MYRTLE BEACH, SC 29579-6706
(843) 236-3222
(843) 236-3005
Mailing address
210 VILLAGE CENTER BLVD STE 140, MYRTLE BEACH, SC 29579-6706
(843) 236-3222
(843) 236-3005
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
TL39293
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39293
MEDICAL LICENSE
SC
05
—
392934
—
SC
Enumeration date
07/07/2010
Last updated
07/20/2022
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