Healthcare Provider Details

I. General information

NPI: 1518964626
Provider Name (Legal Business Name): DAVID SCOTT BJERKEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 HIGHWAY 9 E STE 240
LITTLE RIVER SC
29566-8164
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-366-3755
  • Fax: 843-366-3750
Mailing address:
  • Phone: 843-777-7120
  • Fax: 843-777-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number13600
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number13600
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: