| Doctor Name: | MR. EUGENE ANCRUM |
| NPI Number: | 1043694334 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA |
| License Number: | |
| Business Practice Address: | 1304 W Bobo Newsom Hwy Hartsville, SC - 295504710 |
| Business Phone Number: | 8434063339 |
| Business Fax Number: | |
| Mailing Address: | 24 Ashmore Pl, COLUMBIA |
| State: | SC |
| Postal Code: | 292297087 |
| Phone Number: | 8434063339 |
| Fax Number: | |
| NPI Enumeration Date: | 07/16/2015 |
| NPI Last Update Date: | 11/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |