Basic Information
| Provider Information | |||||||||
| NPI: | 1447453097 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 E CHEVES ST STE 480B | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434321880 | ||||||||
| FaxNumber: | 8434321022 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 E CHEVES ST STE 480B | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434321880 | ||||||||
| FaxNumber: | 8434321022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2007 | ||||||||
| LastUpdateDate: | 02/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 31188 | SC | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 31188 | SC | N | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.