Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 23690 | NC |
NPI | 1073617122 |
---|---|
Provider Name | James B Detorre |
First Address | Charleston, SC 29401-5703 |
Second Address | Charleston, SC 29401-5703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 14/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11054 | (05) | SC |
E14311 | (02) |