Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 27844 | SC |
NPI | 1316025745 |
---|---|
Provider Name | John Thomas Hulvey JR. |
First Address | Daniel Island, SC 29492-8453 |
Second Address | Charleston, SC 29406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 09/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
278443 | (05) | SC |