Healthcare Provider Details

I. General information

NPI: 1023547957
Provider Name (Legal Business Name): PHUOC BUI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 HILLCREST DR STE B
EASLEY SC
29640-1207
US

IV. Provider business mailing address

300 E MCBEE AVE STE 300
GREENVILLE SC
29601-2899
US

V. Phone/Fax

Practice location:
  • Phone: 864-850-5580
  • Fax: 864-855-2581
Mailing address:
  • Phone: 864-695-6734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number801
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number325701
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: