Provider Demographics
NPI:1922099407
Name:BRUGH, REX III (MD)
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:
Last Name:BRUGH
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9 RICHLAND MEDICAL PARK
Mailing Address - Street 2:SUITE 500
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6859
Mailing Address - Country:US
Mailing Address - Phone:803-254-0670
Mailing Address - Fax:803-254-4595
Practice Address - Street 1:9 RICHLAND MEDICAL PARK
Practice Address - Street 2:SUITE 500
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6859
Practice Address - Country:US
Practice Address - Phone:803-254-0670
Practice Address - Fax:803-254-4595
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCSC6455208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC064557Medicaid
SCC60306Medicare UPIN