Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 6403 | SC |
NPI | 1174519011 |
---|---|
Provider Name | James O Merritt |
First Address | Myrtle Beach, SC 29577-5714 |
Second Address | Myrtle Beach, SC 29572-4116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 12/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
064030 | (05) | SC |
D18222 | (02) | SC |