Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | TL33464 | SC |
Y | 207PP0204X | Pediatric Emergency Physician | 33464 | SC |
NPI | 1801062658 |
---|---|
Provider Name | Scott Allen Bloch |
First Address | Atlanta, GA 30374-3904 |
Second Address | Columbia, SC 29203-6896 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2008 |
Last Update Date | 12/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TL33464 | MEDICAL LICENSE (01) | SC |