Provider Demographics
NPI:1780663914
Name:LOBITZ, BRUCE H (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:H
Last Name:LOBITZ
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 1:732 SOUTHLAKE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6819
Mailing Address - Country:US
Mailing Address - Phone:803-419-5142
Mailing Address - Fax:
Practice Address - Street 1:732 SOUTHLAKE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6819
Practice Address - Country:US
Practice Address - Phone:803-419-5142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD020881207P00000X
NC200200137207P00000X
SC18020207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG6438OtherBLUECROSS BLUESHIELD
LA1914398Medicaid
LAG6438OtherBLUECROSS BLUESHIELD
LA5N576CM53Medicare ID - Type Unspecified