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Individual

DR. BENNETT HOWARD BRUCKNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
11 DOCTORS PARK DR STE 240, SPARTANBURG, SC 29307-1008
(864) 342-4115
(864) 342-4064
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
034547
GA
207RG0100X
Gastroenterology Physician
Primary
36622
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00473228A
GA
05
366222
SC
01
SC34105206
MEDICARE PIN
SC
Enumeration date
09/25/2006
Last updated
12/08/2020
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