Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 11962 | SC |
NPI | 1225088784 |
---|---|
Provider Name | Benjamin Shinn Horne III |
First Address | Greenville, SC 29615-4536 |
Second Address | Greenville, SC 29615-3593 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 22/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
119623 | (05) | SC |