Basic Information
| Provider Information | |||||||||
| NPI: | 1306071725 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PANNU | ||||||||
| FirstName: | DAVINDERBIR | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 506 EAST CHEVES STREET | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522739450 | ||||||||
| FaxNumber: | 3522651107 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 E CHEVES ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437777166 | ||||||||
| FaxNumber: | 8437777167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2009 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME111605 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | TRN13805 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 40658 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 40658 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 406581 | 05 | SC | MEDICAID |