Provider Demographics
NPI:1568738466
Name:CLOW, BRIAN DAVID (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:CLOW
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 1:1100 RUTHERFORD RD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-3945
Mailing Address - Country:US
Mailing Address - Phone:865-581-7480
Mailing Address - Fax:864-532-4299
Practice Address - Street 1:1100 RUTHERFORD RD STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-3945
Practice Address - Country:US
Practice Address - Phone:865-581-7480
Practice Address - Fax:864-532-4299
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37992208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC379922Medicaid
SCSC62667951Medicare PIN