Provider Demographics
NPI:1801808548
Name:MCINTYRE, ALEX BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:BRIAN
Last Name:MCINTYRE
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 1:933 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4116
Mailing Address - Country:US
Mailing Address - Phone:843-497-7772
Mailing Address - Fax:843-497-7627
Practice Address - Street 1:933 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4116
Practice Address - Country:US
Practice Address - Phone:843-497-7772
Practice Address - Fax:843-497-7627
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12574174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC12574OtherSC LICENSE NUMBER
SC582426964OtherTAX ID
SC780001419OtherRAILROAD MEDICARE
NC790608TOtherNC MEDICAID
SC125741Medicaid
SC12574OtherSC LICENSE NUMBER
SCD62917Medicare UPIN