Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 28270 | SC |
N | 207PE0004X | Emergency Medical Services | 159466 | MA |
NPI | 1215912548 |
---|---|
Provider Name | Dr. Christo C Courban |
First Address | Conway, SC 29526-9142 |
Second Address | Mullins, SC 29574-6035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 28/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
282704 | (05) | SC |
H29691 | (02) | MA |
H29691 | (02) | SC |