Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25032 | SC |
Y | 207QS0010X | Family Doctor - Sports Medicine | 25032 | SC |
NPI | 1093748386 |
---|---|
Provider Name | Christopher Bice Clemow |
First Address | Anderson, SC 29621-7916 |
Second Address | Anderson, SC 29621-7915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 26/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
250329 | (05) | SC |
I21401 | (02) | SC |