Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 36780 | SC |
NPI | 1003050154 |
---|---|
Provider Name | Hans T Carlson |
First Address | Greenville, SC 29607-6825 |
Second Address | Greenville, SC 29607-6825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2009 |
Last Update Date | 12/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36780 | STATE LICSENCE (01) |