Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 747 | SC |
Y | 208600000X | Surgeon | 747 | SC |
NPI | 1003855578 |
---|---|
Provider Name | Brian Wayne Dach |
First Address | Greenville, SC 29615-4536 |
Second Address | Simpsonville, SC 29681-3266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007478 | (05) | SC |
576007863132 | BLUE CHOICE OF SC (01) | SC |
576007863173 | BCBS OF SC (01) | SC |
P00322763 | RR MEDICARE (01) | SC |