Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 82208 | SC |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 82208 | SC |
NPI | 1134440738 |
---|---|
Provider Name | Jeremy R Mccallum |
First Address | Florence, SC 29502-3239 |
Second Address | Little River, SC 29566-8164 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2010 |
Last Update Date | 22/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
822088 | (05) | SC |
VAD000 | (02) | HI |