Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 9899 | SC |
NPI | 1073691580 |
---|---|
Provider Name | Dr. Fred Leffert |
First Address | Greenville, SC 29615-3749 |
Second Address | Greenville, SC 29601-4046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |