Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 14851 | SC |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 14851 | SC |
NPI | 1427015155 |
---|---|
Provider Name | Dr. Christopher H. Kavolus |
First Address | Greenville, SC 29615-4816 |
Second Address | Greenville, SC 29615-4816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 10/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
148512 | (05) | SC |
8157 | MEDICARE PTAN (01) | SC |
C70471 | (02) | SC |