Individual
BRYAN SCOTT MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 PATEWOOD DR, SUITE C100, GREENVILLE, SC 29615-3593
(864) 454-4260
(864) 676-0898
Mailing address
7 INDEPENDENCE PT, STE 140, GREENVILLE, SC 29615-4566
(864) 797-6044
(864) 797-6195
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
23261
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200044388
RR MEDICARE
SC
01
—
576007863201
BCBS OF SC
SC
05
—
T73603
—
SC
Enumeration date
02/07/2006
Last updated
05/03/2008
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