Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 19172 | SC |
NPI | 1003850595 |
---|---|
Provider Name | Dr. Paul Carl Drago |
First Address | Barnwell, SC 29812-1573 |
Second Address | Barnwell, SC 29812-1573 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 23/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19172 | (05) | SC |
F40632 | (02) |