Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 58966 | GA |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 29469 | SC |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | G85176 | CA |
NPI | 1265479000 |
---|---|
Provider Name | Gregory Hubert Esselman |
First Address | Evans, GA 30809-3000 |
Second Address | Aiken, SC 20596-3808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 15/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4516433 | (05) | CA |
G50232 | (02) | CA |
GP4625 | (05) | SC |