Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MPA.2910 | SC |
N | 2086S0127X | Trauma Surgeon | MPA.2910 | SC |
NPI | 1245748045 |
---|---|
Provider Name | Daniel Kirkley |
First Address | Indian Land, SC 29707-4514 |
Second Address | Indian Land, SC 29707-4514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2018 |
Last Update Date | 29/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3620PA | (05) | SC |