Myrtle Beach Endocrinology
Organization Active NPI Endocrinology, Diabetes & Metabolism Physician · Myrtle Beach, SC
NPI 1083872030 · NPPES record last updated Jul 16, 2008
Key facts
- NPI
- 1083872030
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Endocrinology, Diabetes & Metabolism Physician 207RE0101X
- License
- MD11983 (SC)
- Legal business name
- MYRTLE BEACH ENDOCRINOLOGY
- Practice address
- 1039 44TH Avenue North
Suite 204
Myrtle Beach, SC 29577 - Phone
- (843) 839-3950
- Fax
- (843) 839-3955
- NPI assigned
- May 27, 2008
- Organization subpart
- No
Authorized official
- Name
- Paul David Bunn, MD
- Title
- Physician Owner
- Phone
- (843) 267-1535
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endocrinology, Diabetes & Metabolism Physician |
207RE0101X | MD11983 | SC | Yes |
Addresses
Primary practice location
1039 44TH Avenue North
Suite 204
Myrtle Beach, SC 29577
Mailing address
PO Box 100523
Florence, SC 29501
Phone (843) 669-5162
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119838 | Medicaid | SC | |
| 89064V0 | Medicaid | NC |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.