Individual
RICHARD BRUCE BANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
391 GLENN SPRINGS RD, PACOLET, SC 29372-2417
(864) 474-3013
(864) 474-1501
Mailing address
391 GLENN SPRINGS RD, PACOLET, SC 29372-2417
(864) 474-3013
(864) 474-1501
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
7239
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
072398
—
SC
01
—
P00386835
MEDICARE RAILROAD PTAN#
GA
Enumeration date
05/16/2006
Last updated
09/07/2012
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