Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 7615 | SC |
NPI | 1770619033 |
---|---|
Provider Name | Dr. John Ragan Sanders |
First Address | Greenville, SC 29615-5805 |
Second Address | Greenville, SC 29605-5611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 08/07/2007 |