Healthcare Provider Details

I. General information

NPI: 1629015862
Provider Name (Legal Business Name): MATTHEW ROEHRS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 ROBERTS BLVD
WILLIAMSTON SC
29697-1136
US

IV. Provider business mailing address

PO BOX 100174
COLUMBIA SC
29202-3174
US

V. Phone/Fax

Practice location:
  • Phone: 648-512-5800
  • Fax: 864-512-5292
Mailing address:
  • Phone: 864-512-5800
  • Fax: 864-512-5292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22649
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: