Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 7102 | SC |
N | 208600000X | Surgeon | 7102 | SC |
Y | 2086S0120X | Pediatric Surgery | 7102 | SC |
NPI | 1275591604 |
---|---|
Provider Name | Randel Sease Abrams |
First Address | Greenville, SC 29615-4566 |
Second Address | Greenville, SC 29605-4263 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 21/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
071022 | (05) | SC |
C61112 | (02) | SC |