Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 52550 | SC |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | TMP - 01602 | WV |
NPI | 1992730493 |
---|---|
Provider Name | Brian Kent Heaberlin |
First Address | West Columbia, SC 29171-6069 |
Second Address | West Columbia, SC 29169-4800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 06/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2442280 | (05) | OH |
3810005836 | (05) | WV |
H96185 | (02) | |
P00335936 | RAILROAD (01) |