Provider Demographics
NPI:1306071725
Name:PANNU, DAVINDERBIR S (MD)
Entity type:Individual
Prefix:
First Name:DAVINDERBIR
Middle Name:S
Last Name:PANNU
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 1:506 EAST CHEVES STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2616
Mailing Address - Country:US
Mailing Address - Phone:352-273-9450
Mailing Address - Fax:352-265-1107
Practice Address - Street 1:401 E CHEVES ST STE 301
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2615
Practice Address - Country:US
Practice Address - Phone:843-777-7166
Practice Address - Fax:843-777-7167
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111605207R00000X
FLTRN13805207R00000X
SC40658207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC406581Medicaid
FLGB447ZMedicare PIN