Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 3168 | SC |
Y | 213ES0000X | Sports Medicine | 3168 | SC |
NPI | 1265454219 |
---|---|
Provider Name | Cynthia J Ekman |
First Address | Columbia, SC 29204-2410 |
Second Address | Columbia, SC 29204-2410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 13/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q34226 | (02) | SC |