Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | GA024795 | GA |
NPI | 1366556417 |
---|---|
Provider Name | Raymond Scott Corpe |
First Address | Jacksonville, FL 32256-6017 |
Second Address | Columbia, SC 29230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 01/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000441339B | (05) | GA |
C87970 | (02) | GA |