Healthcare Provider Details

I. General information

NPI: 1235191040
Provider Name (Legal Business Name): JOHN LAWRENCE BENDECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 TAYLOR ST SUITE 6-A
COLUMBIA SC
29201-2923
US

IV. Provider business mailing address

307 PARISH WALK
ELGIN SC
29045-8683
US

V. Phone/Fax

Practice location:
  • Phone: 803-254-2706
  • Fax: 803-254-1318
Mailing address:
  • Phone: 803-736-6657
  • Fax: 803-736-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number15260
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: