Individual
DR. THEODORE J BUNT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 MEDICAL PARK RD, SUITE 300, COLUMBIA, SC 29203-6808
(803) 256-2657
(803) 255-3451
Mailing address
15 MEDICAL PARK RD, SUITE 300, COLUMBIA, SC 29203-8003
(803) 255-3417
(803) 255-3451
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
9984
SC
2086S0129X
Vascular Surgery Physician
Primary
9984
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
099841
—
SC
Enumeration date
04/26/2006
Last updated
10/24/2007
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