Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | SC2826 | SC |
NPI | 1891774162 |
---|---|
Provider Name | Mr. Thomas Herbert Simpson JR. |
First Address | Rock Hill, SC 29732 |
Second Address | Rock Hill, SC 29732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 16/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E95151 | (02) | |
Z28266 | (05) | SC |