Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 10196 | SC |
NPI | 1023092699 |
---|---|
Provider Name | Robert Douglas Devore |
First Address | Greenville, SC 29615-4536 |
Second Address | Greer, SC 29650-2441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 02/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101963 | (05) | SC |
P01034028 | RR MEDICARE (01) | SC |