Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2139 | SC |
NPI | 1063472876 |
---|---|
Provider Name | Dr. John C. Sowell |
First Address | Greenwood, SC 29646-2310 |
Second Address | Greenwood, SC 29646-2310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 10/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T24881 | (02) | SC |
Z21398 | (05) | SC |