Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 35696 | SC |
N | 207VX0201X | Gynecologic Oncologist | 43517 | KY |
NPI | 1457569923 |
---|---|
Provider Name | Jeffrey Wayne Elder |
First Address | Greenville, SC 29615-4536 |
Second Address | Greenville, SC 29605-4255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 22/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
356965 | (05) | SC |