Individual
BRADLEY RENE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
920 DOUG WHITE DR STE 250, MYRTLE BEACH, SC 29572-4181
(843) 236-1950
(843) 236-1952
Mailing address
920 DOUG WHITE DR STE 250, MYRTLE BEACH, SC 29572-4181
(843) 236-1950
(843) 236-1952
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
89592
SC
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
89592
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0614884
MEDICARE ID
OH
05
—
0688788
—
OH
01
—
MA0614881
MEDICARE ID
OH
Enumeration date
12/13/2005
Last updated
07/15/2024
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