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1588803530

NPI Code Detail

MEDICARE: DR. TERRENCE WESTON BRUNER MD

MEDICARE: DR. TERRENCE WESTON BRUNER MD

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	208200000X	Plastic Surgery Physician	31311	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	AA72411153	OTHER	SC	MEDICARE

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	:	1588803530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRENCE WESTON BRUNER MD

Provider Business Mailing Address
First Line	:	PO BOX 100174
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29202-3174
Country	:	US
Telephone Number	:	864-367-0197
Fax Number	:	864-512-2379

Provider Business Practice Location Address
First Line	:	7 LINWA BLVD
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-4486
Country	:	US
Telephone Number	:	864-367-0197
Fax Number	:

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

Provider Enumeration Date	:	02/16/2009
Last Update Date	:	07/21/2017

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Directions to “ DR. TERRENCE WESTON BRUNER MD” Practice Location

Language	Start Address	Practice Location

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