Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 62065 | MN |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 84267 | SC |
N | 207YS0123X | Facial Plastic Surgeon | 32224 | CO |
NPI | 1508974361 |
---|---|
Provider Name | Carol Reid |
First Address | Georgetown, SC 29442-4203 |
Second Address | Myrtle Beach, SC 29577-1663 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 11/06/2021 |