Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 40472 | TN |
Y | 207N00000X | Dermatologist | 7540 | SC |
N | 207NS0135X | Procedural Dermatology | 40472 | TN |
N | 207NS0135X | Procedural Dermatology | 7540 | SC |
NPI | 1366455206 |
---|---|
Provider Name | Dr. Kenneth Ray Warrick |
First Address | Florence, SC 29502-0523 |
Second Address | Little River, SC 29566-8161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 21/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AA9029 | (02) | SC |
B91769 | (02) | SC |
B91769 | (02) | TN |