Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 2018020349 | MO |
Y | 207YS0123X | Facial Plastic Surgeon | 86563 | SC |
NPI | 1639444086 |
---|---|
Provider Name | Jeffrey Steitz |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29615-6306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2012 |
Last Update Date | 10/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | SC |