Provider Demographics
NPI:1033774633
Name:FRESHLEY, BRUCE PALMER JR (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:PALMER
Last Name:FRESHLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:506 E CHEVES ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2616
Mailing Address - Country:US
Mailing Address - Phone:843-390-0100
Mailing Address - Fax:843-390-0038
Practice Address - Street 1:3793 MCDOWELL LANE
Practice Address - Street 2:STE 100
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-7892
Practice Address - Country:US
Practice Address - Phone:843-390-0100
Practice Address - Fax:843-390-0038
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA94991207Q00000X, 207QS0010X
390200000X
SC82649207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program