Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 0361 | SC |
NPI | 1023050143 |
---|---|
Provider Name | Dr. Steven Jeffrey Gottlieb |
First Address | Greenwood, SC 29649-1826 |
Second Address | Greenwood, SC 29649-1826 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 03/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E70189 | (02) | SC |
TL0595 | (05) | SC |