MEDICARE: DR. BRYAN DAVIES DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	SC515	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480035208	OTHER		MEDICARE RAILROAD

General Provider Information

NPI Number	:	1720088149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN DAVIES DPM

Provider Business Mailing Address
First Line	:	6439 GARNERS FERRY RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1638
Country	:	US
Telephone Number	:	803-237-9995
Fax Number	:

Provider Business Practice Location Address
First Line	:	6439 GARNERS FERRY RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209
Country	:	US
Telephone Number	:	803-237-9995
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	05/15/2018

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