Provider Demographics
NPI:1992065858
Name:COAKLEY, BRANDON JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:JAMES
Last Name:COAKLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:917 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:843-449-0453
Mailing Address - Fax:843-449-9531
Practice Address - Street 1:917 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:843-449-0453
Practice Address - Fax:843-449-9531
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCMD40685207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery