Healthcare Provider Details

I. General information

NPI: 1407375991
Provider Name (Legal Business Name): RIBAUT MEDICAL PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 RIBAUT RD
BEAUFORT SC
29902-5437
US

IV. Provider business mailing address

1094 RIBAUT RD
BEAUFORT SC
29902-5437
US

V. Phone/Fax

Practice location:
  • Phone: 843-524-2001
  • Fax:
Mailing address:
  • Phone: 843-524-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License NumberMD26623
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD26623
License Number StateSC

VIII. Authorized Official

Name: SAMUEL CLARK TRASK
Title or Position: GENERAL PARTNER
Credential: MD
Phone: 843-524-2001