Individual
PAUL ROUSSEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-1414
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-3202
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
31182
SC
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
18973
AZ
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
31182
SC
Other
Enumeration date
08/31/2006
Last updated
01/28/2016
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