Provider Demographics
NPI:1518930817
Name:PERCIVAL, BRANDON SCOT (DPM)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:SCOT
Last Name:PERCIVAL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29721-0325
Mailing Address - Country:US
Mailing Address - Phone:803-285-1411
Mailing Address - Fax:803-283-9920
Practice Address - Street 1:1190 HIGHWAY 9 BYP W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-1709
Practice Address - Country:US
Practice Address - Phone:803-285-1411
Practice Address - Fax:803-283-9920
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC536213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD5364Medicaid
SC480028265OtherRAILROAD MEDICARE