Provider Demographics
NPI:1942293857
Name:BROOKS, BEULAH M (DPM)
Entity Type:Individual
Prefix:DR
First Name:BEULAH
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1633
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-0016
Mailing Address - Country:US
Mailing Address - Phone:843-549-6271
Mailing Address - Fax:843-542-9030
Practice Address - Street 1:172 SPRING ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5220
Practice Address - Country:US
Practice Address - Phone:843-722-8628
Practice Address - Fax:843-722-1055
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC123213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC84899OtherMEDCOST
SC9638584OtherGHI
SCDE1790Medicaid
SCS346000OtherCIGNA HEALTHCARE
SC480015086OtherRAILROAD MEDICARE
SCP00374130OtherRAILROAD MEDICARE
SCPD1233Medicaid
SCPD1233Medicaid
SC480015086OtherRAILROAD MEDICARE
SCT510858646Medicare PIN
SCP00374130OtherRAILROAD MEDICARE