Provider Demographics
NPI:1740266725
Name:MCLAURIN, BRENT T (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:T
Last Name:MCLAURIN
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 1:100 PERPETUAL SQ
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1713
Mailing Address - Country:US
Mailing Address - Phone:864-261-7474
Mailing Address - Fax:864-261-8580
Practice Address - Street 1:100 GAVOTTE LN
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-8205
Practice Address - Country:US
Practice Address - Phone:864-261-7474
Practice Address - Fax:864-261-8580
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16339207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC163398Medicaid
SC163398Medicaid
8515Medicare PIN