Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 1337 | SC |
NPI | 1174666283 |
---|---|
Provider Name | Dr. Leonard Edward Mcgaha |
First Address | Anderson, SC 29621-4708 |
Second Address | Anderson, SC 29621-4708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 03/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ZA9593 | (05) | SC |