Basic Information
| Provider Information | |||||||||
| NPI: | 1336183409 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TROGDON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | WARREN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4416 FOREST DR | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292063104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037824278 | ||||||||
| FaxNumber: | 8037823445 | ||||||||
| Practice Location | |||||||||
| Address1: | 2410 HOFFMEYER ROAOD | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295017311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436628182 | ||||||||
| FaxNumber: | 8436628183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 02/06/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 16500 | SC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 16500 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208D00000X | 16500 | SC | N | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 165001 | 05 | SC | MEDICAID |