Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 8854 | SC |
NPI | 1043318553 |
---|---|
Provider Name | Richard G Laurens JR. |
First Address | Greenville, SC 29601-3971 |
Second Address | Greenville, SC 29601-3971 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 10/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D17844 | (02) | SC |