Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 125-055461 | IL |
NPI | 1043473895 |
---|---|
Provider Name | Phillip T Suwan |
First Address | Aiken, SC 29801-6800 |
Second Address | Aiken, SC 29801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 30/05/2018 |