MEDICARE: BRUCE H WELLMON DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	86	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437346475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE H WELLMON DPM

Provider Business Mailing Address
First Line	:	PO BOX 1436
Second Line	:
City	:	GAFFNEY
State	:	SC
Zip	:	29342-1436
Country	:	US
Telephone Number	:	864-487-5516
Fax Number	:	864-487-3477

Provider Business Practice Location Address
First Line	:	101 PROFESSIONAL PARK
Second Line	:
City	:	GAFFNEY
State	:	SC
Zip	:	29340-2319
Country	:	US
Telephone Number	:	864-487-5516
Fax Number	:	864-487-3477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	10/26/2007

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