Provider Demographics
NPI:1962164640
Name:BEHRENS, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BEHRENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 ROSEMEAD RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3735
Mailing Address - Country:US
Mailing Address - Phone:843-297-1618
Mailing Address - Fax:
Practice Address - Street 1:1115 ROSEMEAD RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3735
Practice Address - Country:US
Practice Address - Phone:843-297-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-09
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver