Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 34665 | SC |
Y | 207QS0010X | Family Doctor - Sports Medicine | 34665 | SC |
NPI | 1336400159 |
---|---|
Provider Name | Philip Stonecypher |
First Address | Greenville, SC 29611-7423 |
Second Address | Greenville, SC 29611-7423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2012 |
Last Update Date | 25/02/2019 |