Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD52317 | SC |
NPI | 1073958989 |
---|---|
Provider Name | Dr. Jacob Patrick Ossoff |
First Address | Lugoff, SC 29078-9198 |
Second Address | Lugoff, SC 29078-9198 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2013 |
Last Update Date | 26/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
523179 | (05) | SC |