Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 387 | SC |
NPI | 1043307614 |
---|---|
Provider Name | Mr. Bruce David Filler |
First Address | Columbia, SC 29204-2257 |
Second Address | Columbia, SC 29204-2257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q23115 | (02) | |
TH1590 | (05) | SC |