Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 90 | SC |
Y | 222Z00000X | Podiatrist | 90 | SC |
NPI | 1023006178 |
---|---|
Provider Name | Dr. Gery Brian Katalinich |
First Address | Myrtle Beach, SC 29588-4503 |
Second Address | Myrtle Beach, SC 29588-4503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 16/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PD0902 | (05) | SC |
U19920 | (02) | SC |