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General NPI Number Information
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NPI Number | 1700882776
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Entity Type | Individual
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Provider Name | ROBERT BRUCE BORUCKI MD
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Gender | Male
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 1911 HAMPTON ST
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City | COLUMBIA
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State | SC
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Zip | 29201
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Country | US
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Telephone | 803-256-1511
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Fax | 803-256-7333
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Provider Business Mailing Address
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Address Line | 3321 FOREST DRIVE SUITE 4
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City | COLUMBIA
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State | SC
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Zip | 29204
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Country | US
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Telephone | 803-661-9519
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Fax | 803-661-9819
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 013376
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 13376
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License Number State | SC
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