Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 16788 | SC |
NPI | 1013555671 |
---|---|
Provider Name | Merritt Mccoy Tolan |
First Address | Florence, SC 29501-2808 |
Second Address | Florence, SC 29506-2851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2019 |
Last Update Date | 19/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
167884 | (05) | SC |