Provider Demographics
NPI:1124266911
Name:BRUYERE, CHARLES FRANK (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:FRANK
Last Name:BRUYERE
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 1:464-B NW 72 BYPASS
Mailing Address - Street 2:COLOR ME WELL URGENT CARE
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649
Mailing Address - Country:US
Mailing Address - Phone:864-943-1143
Mailing Address - Fax:864-943-2066
Practice Address - Street 1:464-B NW 72 BYPASS
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649
Practice Address - Country:US
Practice Address - Phone:864-943-1143
Practice Address - Fax:864-943-2066
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC20043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine