Provider Demographics
NPI:1093782229
Name:ELEAZER, G PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:G
Middle Name:PAUL
Last Name:ELEAZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:15 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-8003
Mailing Address - Country:US
Mailing Address - Phone:803-255-3422
Mailing Address - Fax:803-255-3451
Practice Address - Street 1:2 MEDICAL PARK RD
Practice Address - Street 2:SUITE 502
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6808
Practice Address - Country:US
Practice Address - Phone:803-540-1000
Practice Address - Fax:803-255-3451
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC12974207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC129747Medicaid
B920302603Medicare ID - Type Unspecified
SCB920302603Medicare PIN
SC129747Medicaid