Individual
DOMINIC BRUNO GAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 PATEWOOD DR, STE A330, GREENVILLE, SC 29615-3593
(864) 454-5660
(864) 241-9233
Mailing address
300 E MCBEE AVE, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
2080S0012X
Pediatric Sleep Medicine Physician
Primary
29065
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290651
—
SC
Enumeration date
08/20/2006
Last updated
05/14/2021
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