Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 38380 | SC |
NPI | 1013233097 |
---|---|
Provider Name | Hector Rodriguez JR. |
First Address | Skyland, NC 28776-2137 |
Second Address | West Columbia, SC 29169-3456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2010 |
Last Update Date | 16/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SC62386874 | MEDICARE PTAN (01) | SC |