Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 53823 | MN |
Y | 208800000X | Urologist | 82800 | SC |
NPI | 1023019734 |
---|---|
Provider Name | Dr. Laurence T O'connor |
First Address | Atlanta, GA 30374-3904 |
Second Address | Columbia, SC 29201-2946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 09/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
828000 | (05) | SC |