Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 11396 | SC |
NPI | 1942251517 |
---|---|
Provider Name | Dr. Michael K Drakeford |
First Address | Sumter, SC 29150-1969 |
Second Address | Sumter, SC 29150-1969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 29/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B92176 | (02) | SC |
SC11396 | SCLICENSE NUMBER (01) | SC |