Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD23944 | SC |
NPI | 1164518494 |
---|---|
Provider Name | Eloise J. Prijoles |
First Address | Greenwood, SC 29646-2316 |
Second Address | Columbia, SC 29201-2375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 18/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
276815100 | (05) | FL |
59232 | BCBS (01) | FL |