Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 7485 | SC |
N | 208200000X | Surgeon | 7485 | SC |
N | 208600000X | Surgeon | 7485 | SC |
NPI | 1427107150 |
---|---|
Provider Name | Stephen J Kroll |
First Address | Columbia, SC 29212-2248 |
Second Address | Columbia, SC 29212-2248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
074859 | (05) | SC |
7485 | SC LICENSE (01) | SC |
B91823 | (02) |