Provider Demographics
NPI:1477510618
Name:GIFFORD, ROBERT RICHARD MURRRAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RICHARD MURRRAY
Last Name:GIFFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6808
Mailing Address - Country:US
Mailing Address - Phone:803-256-2657
Mailing Address - Fax:803-434-7349
Practice Address - Street 1:2 MEDICAL PARK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6808
Practice Address - Country:US
Practice Address - Phone:803-256-2657
Practice Address - Fax:803-434-7349
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC60592086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC060597Medicaid
B34002Medicare UPIN
SC060597Medicaid
SCB340021955Medicare PIN