Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 3428 | SC |
NPI | 1619101151 |
---|---|
Provider Name | Ms. Regina Ann Koder |
First Address | Columbia, SC 29229-6535 |
Second Address | Columbia, SC 29204-4041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2009 |
Last Update Date | 12/05/2009 |