Provider Demographics
NPI:1841286085
Name:SCHOBER, BRUCE R (DO)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:R
Last Name:SCHOBER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109B FLEETWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-2019
Mailing Address - Country:US
Mailing Address - Phone:864-855-1036
Mailing Address - Fax:864-855-3318
Practice Address - Street 1:109B FLEETWOOD DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2019
Practice Address - Country:US
Practice Address - Phone:864-855-1036
Practice Address - Fax:864-855-3318
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC008510Medicaid
SCPA4726OtherGROUP MEDICAID NUMBER
SC008510Medicaid
SCD93075Medicare UPIN