Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 24039 | SC |
NPI | 1063483428 |
---|---|
Provider Name | Dr. Edward A. Kotz III |
First Address | Charleston, SC 29407 |
Second Address | Charleston, SC 29407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 05/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
240395 | (05) | SC |
I24579 | (02) | SC |