Provider Demographics
NPI:1134148547
Name:BOTTOMY, DAVID PAUL (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:BOTTOMY
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 1:1706 2ND LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6119
Mailing Address - Country:US
Mailing Address - Phone:843-629-8084
Mailing Address - Fax:843-629-8684
Practice Address - Street 1:1706 2ND LOOP RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6119
Practice Address - Country:US
Practice Address - Phone:843-629-8084
Practice Address - Fax:843-629-8684
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21587207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0965Medicaid
SCGP0965Medicaid
H12777Medicare UPIN