Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 83871 | SC |
NPI | 1043637481 |
---|---|
Provider Name | Dr. Ian Gao |
First Address | Spartanburg, SC 29303-4219 |
Second Address | Spartanburg, SC 29303-4219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2014 |
Last Update Date | 05/08/2020 |