Provider Demographics
NPI:1699826743
Name:BRUKER, WILLIAM C JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:BRUKER
Suffix:JR
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 1:325 COLLETON AVE
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-7101
Mailing Address - Country:US
Mailing Address - Phone:803-649-0308
Mailing Address - Fax:
Practice Address - Street 1:300 RIDGE MEDICAL PLAZA
Practice Address - Street 2:
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824
Practice Address - Country:US
Practice Address - Phone:803-637-1173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20-099822085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC099828Medicaid
SC099828Medicaid
SCD179330281Medicare ID - Type Unspecified