Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 19877 | SC |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 19877 | SC |
NPI | 1114013570 |
---|---|
Provider Name | Joel C Phillips |
First Address | Greenville, SC 29605-4267 |
Second Address | Greenville, SC 29605-4267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 28/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
198770 | (05) | SC |
G82348 | (02) | SC |