Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 22756 | SC |
NPI | 1013975093 |
---|---|
Provider Name | Thomas P Paxton |
First Address | King Of Prussia, PA 19406-3121 |
Second Address | Aiken, SC 29801-6351 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 08/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020613680 | BLUE CROSS PIN NUMBER (01) | SC |
T70296 | (05) | SC |