Provider Demographics
NPI:1033322854
Name:EASTERN SHORE FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:EASTERN SHORE FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:BRUMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-626-1175
Mailing Address - Street 1:27961 US HIGHWAY 98
Mailing Address - Street 2:SUITE 14
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4702
Mailing Address - Country:US
Mailing Address - Phone:251-626-1175
Mailing Address - Fax:
Practice Address - Street 1:27961 US HIGHWAY 98
Practice Address - Street 2:SUITE 14
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4702
Practice Address - Country:US
Practice Address - Phone:251-626-1175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC72033Medicare UPIN
ALC72154Medicare UPIN
ALG38756Medicare UPIN
ALE77476Medicare UPIN