Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 84756 | SC |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 85756 | SC |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | BP10050654 | TX |
N | 2086X0206X | Surgical Oncologist | 85756 | SC |
NPI | 1184035628 |
---|---|
Provider Name | Jordan W Rawl |
First Address | West Columbia, SC 29171-6069 |
Second Address | West Columbia, SC 29169-4800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2014 |
Last Update Date | 11/11/2020 |