Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 2308 | SC |
NPI | 1124535547 |
---|---|
Provider Name | Emma O'keefe |
First Address | Gaffney, SC 29340-3778 |
Second Address | Gaffney, SC 29340-3778 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2018 |
Last Update Date | 08/01/2018 |