Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 14870 | SC |
Y | 207YS0123X | Facial Plastic Surgeon | 14870 | SC |
NPI | 1245204791 |
---|---|
Provider Name | Dr. John Smythe Rich III |
First Address | Columbia, SC 29201-2635 |
Second Address | Columbia, SC 29201-2635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 01/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
148708 | (05) | SC |
E01523 | (02) |