Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 51283 | SC |
NPI | 1629096763 |
---|---|
Provider Name | Dr. Alexander Dix Soutter |
First Address | Summerville, SC 29485-5901 |
Second Address | Summerville, SC 29485-5901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 10/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
512831 | (05) | SC |