Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 21083 | SC |
NPI | 1164414926 |
---|---|
Provider Name | Wayne Franklin Sease JR. |
First Address | Greenville, SC 29601-2842 |
Second Address | Greer, SC 29650-2456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 11/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8913461 | (05) | NC |
G91632 | (02) | |
P00464118 | RR MEDICARE (01) | SC |
P00801273 | RR MEDICARE (01) | SC |