Provider Demographics
NPI:1982668646
Name:FUNKE, JOHN III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:FUNKE
Suffix:III
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 1:8526 OYSTER FACTORY RD
Mailing Address - Street 2:
Mailing Address - City:EDISTO ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29438-6876
Mailing Address - Country:US
Mailing Address - Phone:864-337-2899
Mailing Address - Fax:
Practice Address - Street 1:100 BUCKWALTER PLACE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5023
Practice Address - Country:US
Practice Address - Phone:843-208-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC119302085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC02340337OtherBCBS
SC119302Medicaid
D17460Medicare UPIN
SC119302Medicaid