Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0200X | Radiology | 130 | SC |
N | 213ER0200X | Radiology | 130 | SC |
Y | 213ES0131X | Foot Surgery | 130 | SC |
NPI | 1578525820 |
---|---|
Provider Name | Dr. Paul Richard Bearden |
First Address | West Columbia, SC 29171-6069 |
Second Address | Lexington, SC 29072-6690 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 13/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U48678 | (02) | SC |