Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 0368 | SC |
NPI | 1043370182 |
---|---|
Provider Name | Dr. Robert Jay Gohean |
First Address | Columbia, SC 29210-3841 |
Second Address | Columbia, SC 29210-3841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |