Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 26037 | SC |
Y | 208600000X | Surgeon | 26037 | SC |
NPI | 1013962646 |
---|---|
Provider Name | John David Scott |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29607-4029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 11/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
260372 | (05) | SC |