Provider Demographics
NPI:1689638165
Name:BRAND, ALFREDO JORGE (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:JORGE
Last Name:BRAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2330
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-2330
Mailing Address - Country:US
Mailing Address - Phone:843-837-4400
Mailing Address - Fax:843-837-4440
Practice Address - Street 1:25 HOSPITAL CENTER COMMON
Practice Address - Street 2:SUITE 200
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2841
Practice Address - Country:US
Practice Address - Phone:843-689-5002
Practice Address - Fax:843-689-3690
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15685207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCBB2810340OtherDEA
C10289Medicare UPIN