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General NPI Number Information
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NPI Number | 1912959362
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Entity Type | Individual
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Provider Name | RICHARD BRUCE BANNON MD
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 391 GLENN SPRINGS RD
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City | PACOLET
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State | SC
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Zip | 29372-2417
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Country | US
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Telephone | 864-474-3013
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Fax | 864-474-1501
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Provider Business Mailing Address
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Address Line | 391 GLENN SPRINGS RD
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City | PACOLET
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State | SC
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Zip | 29372-2417
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Country | US
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Telephone | 864-474-3013
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Fax | 864-474-1501
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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 | 7239
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License Number State | SC
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