Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 19130 | SC |
NPI | 1174561864 |
---|---|
Provider Name | Augusto Morales |
First Address | Greenville, SC 29615-4536 |
Second Address | Greenville, SC 29615-3547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 15/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D16676 | (02) | SC |