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NPI Code Detail

MEDICARE: DR. RICHARD HENRY HUSSEY III M.D.

MEDICARE:  DR. RICHARD HENRY HUSSEY III M.D.
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
1207N00000XDermatology Physician19296SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1203655134OTHERSCTAX ID

General Provider Information

NPI Number : 1558365346
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD HENRY HUSSEY III M.D.
Provider Business Mailing Address
First Line : 1275 21ST AVE N BLDG 2
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29577-7514
Country : US
Telephone Number : 843-449-9140
Fax Number : 843-497-5110
Provider Business Practice Location Address
First Line : 1275 21ST AVE N BLDG 2
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29577-7514
Country : US
Telephone Number : 843-449-9140
Fax Number : 843-497-5110
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 01/30/2024

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