Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 035 | SC |
Y | 222Z00000X | Podiatrist | 035 | SC |
NPI | 1023105913 |
---|---|
Provider Name | James A Suber |
First Address | Columbia, SC 29201-2607 |
Second Address | Columbia, SC 29201-2607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |