Individual
JOHN SCOTT BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
480 FLOYD RD, SUITE A, SPARTANBURG, SC 29307-1518
(864) 582-2188
(864) 582-2117
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
16584
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165840
—
SC
01
—
200032060
RR MEDICARE
SC
01
—
4460681
CIGNA
SC
01
—
5391725
AETNA
SC
01
—
576007863084
BCBS OF SC
SC
01
—
P00797721
RR MEDICARE
SC
Enumeration date
05/12/2006
Last updated
03/15/2023
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