Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 5395 | SC |
NPI | 1003844044 |
---|---|
Provider Name | Dr. Larry D Rabon |
First Address | Florence, SC 29501-4723 |
Second Address | Florence, SC 29501-4723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 14/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
053952 | (05) | SC |
C60685 | (02) | SC |