Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 14493 | SC |
NPI | 1013993583 |
---|---|
Provider Name | Dr. Deanna L Constable |
First Address | Columbia, SC 29223-5959 |
Second Address | Columbia, SC 29223-5959 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 03/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
144935 | (05) | SC |
F70096 | (02) | SC |