Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 33172 | SC |
NPI | 1659363133 |
---|---|
Provider Name | Robert L Gates |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29605-4263 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 14/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
APPROVED | (05) | SC |