Individual
DR. KURT RICHARD ELLENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
BEAUFORT MEMORIAL EXPRESS CARE & OCCUPATIONAL HEALTH, 974 RIBAUT RD, BEAUFORT, SC 29902
(843) 524-3344
(844) 295-9894
Mailing address
955 RIBAUT RD, BMAC CREDENTIALING, BEAUFORT, SC 29902-5441
(843) 522-5674
(843) 522-5678
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
19453
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19453
SC LICENSE BOARD
SC
05
—
194532
—
SC
Enumeration date
04/19/2006
Last updated
05/08/2019
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