Provider Demographics
NPI:1437578259
Name:ALFORD, BRYAN MATTHEW (PA-C)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:MATTHEW
Last Name:ALFORD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 CENTER STREET
Mailing Address - Street 2:SC HOUSE CALLS INC
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:1053 CENTER STREET
Practice Address - Street 2:SC HOUSE CALLS INC
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:843-777-7102
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC363AS0400X
SC2135363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1934PAMedicaid
SCSC41587628OtherMEDICARE PIN