Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 16908 | SC |
N | 207ND0101X | MOHS-Micrographic Surgeon | 16908 | SC |
N | 207ND0900X | Dermatopathologist | 16908 | SC |
NPI | 1275685000 |
---|---|
Provider Name | Mark Johnson Quarterman |
First Address | Anderson, SC 29621-1504 |
Second Address | Anderson, SC 29621-1504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F62908 | (02) | |
JL7847 | (05) | SC |