Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | MD.206139 | LA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | MD.206139 | LA |
NPI | 1063687325 |
---|---|
Provider Name | Dr. David Watson Rodwell III |
First Address | Charleston, SC 29401-2936 |
Second Address | Charleston, SC 29401-2936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2008 |
Last Update Date | 02/11/2014 |