Individual
RUSSELL E. DITZLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
109 BARTON CREEK COURT, COLUMBIA, SC 29229
(803) 256-2286
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12852
SC
207QS1201X
Sleep Medicine (Family Medicine) Physician
12852
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12852
DITZLER STATE LICENSE #
SC
05
—
128524
—
SC
Enumeration date
04/27/2006
Last updated
10/27/2020
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