Individual
BRUCE MALLORY BURNS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 N FANT ST, ANDERSON, SC 29621-5708
(864) 226-0511
(864) 231-7018
Mailing address
211 S MAIN ST, ANDERSON, SC 29624-1620
(864) 226-0511
(864) 231-7018
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
13947
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00259223C
MEDICAID
GA
01
—
300020824
RAIL ROAD MEDICARE
SC
01
—
57-0853635
CHAMPUS
SC
05
—
TL4055
—
SC
Enumeration date
01/12/2007
Last updated
10/09/2007
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