Provider Demographics
NPI:1285946269
Name:BROTHERS, JUSTIN GERARD (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:GERARD
Last Name:BROTHERS
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 1:210 VILLAGE CENTER BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6706
Mailing Address - Country:US
Mailing Address - Phone:843-236-3222
Mailing Address - Fax:843-236-3005
Practice Address - Street 1:210 VILLAGE CENTER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-6706
Practice Address - Country:US
Practice Address - Phone:843-236-3222
Practice Address - Fax:843-236-3005
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SCTL39293207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC39293OtherMEDICAL LICENSE
SC392934Medicaid
SCSC84042221Medicare PIN