Provider Demographics
NPI:1225103302
Name:FORBUS, BRIAN D (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:FORBUS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2767 CULTRA RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3716
Mailing Address - Country:US
Mailing Address - Phone:843-438-8470
Mailing Address - Fax:
Practice Address - Street 1:2767 CULTRA RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3716
Practice Address - Country:US
Practice Address - Phone:843-438-8470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA773363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0060PAMedicaid
SCP00803331OtherRAILROAD MEDICARE-RSFPN
SCP663049223Medicare PIN
SCP00803331OtherRAILROAD MEDICARE-RSFPN