Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 12307 | SC |
NPI | 1013907690 |
---|---|
Provider Name | Gary A Vukov |
First Address | Myrtle Beach, SC 29572-3055 |
Second Address | Myrtle Beach, SC 29572-3055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 22/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123075 | (05) | SC |
A57142 | (02) |