MEDICARE: DR. DAVID RUSSELL TRIGG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	18211	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18211	OTHER	SC	STATE LICENSE

General Provider Information

NPI Number	:	1134138167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID RUSSELL TRIGG MD

Provider Business Mailing Address
First Line	:	325 BROAD ST
Second Line	:	STE 100
City	:	SUMTER
State	:	SC
Zip	:	29150-4167
Country	:	US
Telephone Number	:	803-773-5227
Fax Number	:	803-753-9312

Provider Business Practice Location Address
First Line	:	325 BROAD ST
Second Line	:	SUITE 100
City	:	SUMTER
State	:	SC
Zip	:	29150-4167
Country	:	US
Telephone Number	:	803-773-5227
Fax Number	:	803-753-9312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	06/10/2021

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