Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 11281 | SC |
Y | 208600000X | Surgeon | 11281 | SC |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 11281 | SC |
NPI | 1114985140 |
---|---|
Provider Name | Dr. Gajanan Ramnath Shanbhag |
First Address | Woodruff, SC 29388-2328 |
Second Address | Woodruff, SC 29388-2328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 06/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112817 | (05) | SC |