Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 7184 | SC |
NPI | 1083605752 |
---|---|
Provider Name | Dr. Roger E Stevenson |
First Address | Greenwood, SC 29646-2316 |
Second Address | Greenwood, SC 29646-2315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 18/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
071843 | (05) | SC |
480223 | (05) | SC |
D17911 | (02) | SC |