Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 11332 | SC |
NPI | 1023159431 |
---|---|
Provider Name | Mark S. Keisler |
First Address | Lexington, SC 29072-2606 |
Second Address | Lexington, SC 29072-2606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B92154 | (02) | SC |