Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 2020662 | SC |
NPI | 1033158779 |
---|---|
Provider Name | Mr. Balbir S Minhas |
First Address | Irmo, SC 29063-2872 |
Second Address | Irmo, SC 29063-2872 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 20/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100014428 | RR MEDICARE (01) | |
206627 | (05) | SC |
F80242 | (02) |