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General NPI Number Information
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NPI Number | 1679563019
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Entity Type | Individual
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Provider Name | BRUCE K BARACH MD
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 14490 OCEAN HWY
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City | PAWLEYS ISLAND
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State | SC
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Zip | 29585-4821
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Country | US
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Telephone | 843-881-4440
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Fax | 843-314-0785
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Provider Business Mailing Address
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Address Line | 801 YORK ST
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City | MANITOWOC
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State | WI
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Zip | 54220-4630
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Country | US
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Telephone | 920-663-9008
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Fax | 920-684-1439
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 34698
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License Number State | SC
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