Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 4841 | SC |
NPI | 1154311306 |
---|---|
Provider Name | Thomas L Tiller JR. |
First Address | Greenville, SC 29615-4800 |
Second Address | Greenville, SC 29615-4800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 13/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
048415 | (05) | SC |
D17825 | (02) |