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Individual

JOYCE M BRACKEBUSCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
146 E HOSPITAL DR STE 200, WEST COLUMBIA, SC 29169-4800
(803) 936-7530
(803) 936-7532
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
(803) 791-2000

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
89330
SC
207Y00000X
Otolaryngology Physician
Primary
MD20476
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
150605
OR
Enumeration date
11/01/2006
Last updated
01/17/2024
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