Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 10233 | SC |
Y | 207RI0011X | Interventional Cardiology | 10233 | SC |
NPI | 1073549291 |
---|---|
Provider Name | Lanneau D Lide JR. |
First Address | Columbia, SC 29204-1018 |
Second Address | Columbia, SC 29204-1018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 24/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102338 | (05) | SC |
B91787 | (02) | SC |