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NPI Code Detail

MEDICARE: JOHN BRIAN UDALL MD

MEDICARE: JOHN BRIAN UDALL 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
12085R0202XDiagnostic Radiology Physician22825SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2300129735OTHERRAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number : 1851390884
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN BRIAN UDALL MD
Provider Business Mailing Address
First Line : 300 E MCBEE AVE FL 4
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2842
Country : US
Telephone Number : 864-522-8603
Fax Number :
Provider Business Practice Location Address
First Line : 1210 W FARIS RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29605-4444
Country : US
Telephone Number : 864-522-1800
Fax Number : 864-522-1806
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2005
Last Update Date : 12/09/2022

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Directions to “ JOHN BRIAN UDALL MD” Practice Location

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