Provider Demographics
NPI:1194808832
Name:MCINNIS, DAVID MURRAY (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MURRAY
Last Name:MCINNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:MCINNIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:304 EAST MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512
Mailing Address - Country:US
Mailing Address - Phone:843-479-3837
Mailing Address - Fax:843-479-3931
Practice Address - Street 1:304 EAST MARKET STREET
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512
Practice Address - Country:US
Practice Address - Phone:843-479-3837
Practice Address - Fax:843-479-3931
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA0098Medicaid
SC1566Medicare ID - Type Unspecified
B92011Medicare UPIN
SCPA0098Medicaid