Healthcare Provider Details

I. General information

NPI: 1609852763
Provider Name (Legal Business Name): JOSE M ALBERT JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSEPH M ALBERT JR. MD

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 N HOSPITAL DR STE 430
WEST COLUMBIA SC
29169-4800
US

IV. Provider business mailing address

PO BOX 896239
CHARLOTTE NC
28289-6239
US

V. Phone/Fax

Practice location:
  • Phone: 803-791-2828
  • Fax:
Mailing address:
  • Phone: 803-791-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number13344
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: