Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 16987 | SC |
NPI | 1508945353 |
---|---|
Provider Name | Dr. Lee Ridges |
First Address | Bennettsville, SC 29512-2541 |
Second Address | Florence, SC 29506-2526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F75781 | (02) | NC |