Provider Demographics
NPI:1922203371
Name:WILLIAMS, BRUCE BARRY (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:BARRY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 PELHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118
Mailing Address - Country:US
Mailing Address - Phone:803-395-3737
Mailing Address - Fax:803-531-0133
Practice Address - Street 1:2850 PELHAM ROAD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118
Practice Address - Country:US
Practice Address - Phone:803-395-3737
Practice Address - Fax:803-531-0133
Is Sole Proprietor?:No
Enumeration Date:2007-06-17
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60850-21207V00000X
GA062794207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102841321Medicaid
PA303471Medicare PIN