Basic Information
| Provider Information | |||||||||
| NPI: | 1992919393 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAIRD | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | BRUCE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 INDEPENDENCE PT | ||||||||
| Address2: | STE 212 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976044 | ||||||||
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| Practice Location | |||||||||
| Address1: | 333 S PINE ST | ||||||||
| Address2: | |||||||||
| City: | SPARTANBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293022622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645157500 | ||||||||
| FaxNumber: | 8645157501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 04/07/2016 | ||||||||
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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 | 207P00000X | 33787 | SC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PS0010X | 33787 | SC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 337870 | 05 | SC | MEDICAID |