Provider Demographics
NPI:1669457966
Name:WEIRICK, BRIAN E (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:WEIRICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22580 HIGHWAY 76 E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-8439
Mailing Address - Country:US
Mailing Address - Phone:864-833-0055
Mailing Address - Fax:864-833-4008
Practice Address - Street 1:22580 HIGHWAY 76 E
Practice Address - Street 2:SUITE 200
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-8439
Practice Address - Country:US
Practice Address - Phone:864-833-0055
Practice Address - Fax:864-833-4008
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL0399Medicaid
SCF533435019Medicare PIN
SCTL0399Medicaid
SCF533439068Medicare PIN