Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 36855 | SC |
NPI | 1003221623 |
---|---|
Provider Name | David Markus Diamant |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29605-4296 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2014 |
Last Update Date | 07/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
368550 | (05) | SC |