Provider Demographics
NPI:1730319351
Name:BREWTON, MARY SUE K (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:SUE K
Last Name:BREWTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7098
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:3015 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5935
Practice Address - Country:US
Practice Address - Phone:843-777-6870
Practice Address - Fax:843-777-6871
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1285207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC012854Medicaid
SCAA95285193Medicare PIN
SCAA9528A6067Medicare PIN