Basic Information
Provider Information | |||||||||
NPI: | 1285671115 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DRUKKER | ||||||||
FirstName: | BRUCE | ||||||||
MiddleName: | H | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 INDEPENDENCE PT | ||||||||
Address2: | SUITE 212 | ||||||||
City: | GREENVILLE | ||||||||
State: | SC | ||||||||
PostalCode: | 296154545 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8647976044 | ||||||||
FaxNumber: | 8647976198 | ||||||||
Practice Location | |||||||||
Address1: | 890 W FARIS RD | ||||||||
Address2: | SUITE 470 | ||||||||
City: | GREENVILLE | ||||||||
State: | SC | ||||||||
PostalCode: | 296054247 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8644551600 | ||||||||
FaxNumber: | 8644553095 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/31/2006 | ||||||||
LastUpdateDate: | 04/27/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 18973 | SC | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 189735 | 05 | SC |   | MEDICAID | 576007863107 | 01 | SC | BCBS OF SC | OTHER | 160057952 | 01 | SC | RR MEDICARE | OTHER | 7548491 | 01 | SC | AETNA | OTHER | 0584313 | 01 | SC | CIGNA | OTHER | 576007863029 | 01 | SC | BLUE CHOICE OF SC | OTHER |