Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 14132 | SC |
NPI | 1013920511 |
---|---|
Provider Name | Dr. Michael Keith Herrin |
First Address | Florence, SC 29501-0523 |
Second Address | Conway, SC 29526-9142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 09/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
141322 | (05) | SC |
CC4331 | RAILROAD MEDICARE GROUP (01) | |
F10460 | (02) | SC |
P00631106 | RAILROAD MEDICARE INDIVIDUAL (01) | SC |