Bruckner, Bennett Howard

Bruckner, Bennett Howard is an individual health care provider with primary practice located at 11 Doctors Park Dr Ste 240 , Spartanburg SC 29307-1008. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Bruckner, Bennett Howard can be contacted via phone (864) 342-4115.

Contact Information

Primary practice address
11 Doctors Park Dr Ste 240 Spartanburg SC 29307-1008
Phone: (864) 342-4115
Fax: (864) 342-4064
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 034547 Georgia
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 36622 South Carolina

Profile Details

NPI number 1639270622
LBN Legal business name Bruckner, Bennett Howard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 25th, 2006
Last updated Dec 8th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639270622 NPPES
Georgia MEDICAID 00473228A
Georgia MEDICAID 366222
Georgia Other SC34105206

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