Provider Demographics
NPI:1780656595
Name:BURRUS, EDWARD PERRY III (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PERRY
Last Name:BURRUS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1055 RIBAUT RD
Mailing Address - Street 2:STE 30
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5447
Mailing Address - Country:US
Mailing Address - Phone:843-524-8171
Mailing Address - Fax:843-525-6613
Practice Address - Street 1:1055 RIBAUT RD
Practice Address - Street 2:STE 30
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5447
Practice Address - Country:US
Practice Address - Phone:843-524-8171
Practice Address - Fax:843-525-6613
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC16562208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC165626Medicaid
F37123Medicare UPIN