Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 36287 | SC |
N | 208D00000X | General Practice Physician | 36287 | SC |
NPI | 1205032638 |
---|---|
Provider Name | Sterling Wagner Simpson |
First Address | Greenville, SC 29609-4603 |
Second Address | Greenville, SC 29615-3593 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 03/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
362878 | (05) | SC |