Provider Demographics
NPI:1578786075
Name:BLAIR, BRIAN K (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:BLAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 VILLAGE CENTER BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6706
Mailing Address - Country:US
Mailing Address - Phone:843-353-3460
Mailing Address - Fax:843-353-3461
Practice Address - Street 1:3545 HIGHWAY 17
Practice Address - Street 2:SUITE 200
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5113
Practice Address - Country:US
Practice Address - Phone:843-294-1941
Practice Address - Fax:843-294-0597
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29468207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC000000245124OtherUNISON
SC055OtherBCBS
SC18500OtherEVOLUTIONS
NC5909643OtherNC MEDICAID
SCAA19548552OtherMEDICAREPTAN
SC053OtherBLUE CHOICE
SC208805OtherMEDCOST
SC9956198OtherAETNA
SC294684Medicaid
SC294684Medicaid