Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1275766917 |
---|---|
Provider Name | Benjamin R Tigner |
First Address | Fort Mill, SC 29707-5840 |
Second Address | Fort Mill, SC 29707-5840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2009 |
Last Update Date | 05/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7795444 | (05) | NC |