Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 39005 | SC |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 39005 | SC |
NPI | 1164482683 |
---|---|
Provider Name | Dr. Robert Lafitte Eller |
First Address | Greenville, SC 29605-4266 |
Second Address | Greenville, SC 29605-4266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 14/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
390053 | (05) | SC |