Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 13703 | SC |
NPI | 1053310110 |
---|---|
Provider Name | Winston Wallace Vaught JR. |
First Address | Florence, SC 29502-3239 |
Second Address | Florence, SC 29506-2650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 05/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
137033 | (05) | SC |
D18282 | (02) | SC |