Provider Demographics
NPI:1518964626
Name:BJERKEN, DAVID SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:BJERKEN
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7120
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:3980 HIGHWAY 9 E STE 240
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8164
Practice Address - Country:US
Practice Address - Phone:843-366-3755
Practice Address - Fax:843-366-3750
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC136002086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC136007Medicaid
FLU14444Medicare ID - Type Unspecified
FLP00077477Medicare PIN
E83967Medicare UPIN