Healthcare Provider Details

I. General information

NPI: 1801956222
Provider Name (Legal Business Name): CRUDDIE L. TORIAN, SR, DPM, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 WILDEWOOD PARK DR
COLUMBIA SC
29223-4300
US

IV. Provider business mailing address

PO BOX 24587
COLUMBIA SC
29224-4587
US

V. Phone/Fax

Practice location:
  • Phone: 803-462-7040
  • Fax: 803-462-7047
Mailing address:
  • Phone: 803-462-7040
  • Fax: 803-462-7047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number138
License Number StateSC

VIII. Authorized Official

Name: DR. CRUDDIE L TORIAN SR.
Title or Position: OWNER
Credential: DPM
Phone: 803-462-7040