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Physicians Surgery

Provider NPI: 1205810041

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
845 82ND PKWY  MYRTLE BEACH, SC 29572-4614 US
Tel: 843-449-9621  Fax: 843-449-4921

Business Mailing Address:
845 82ND PKWY  MYRTLE BEACH, SC 29572-4614 US
Tel: 843-449-9621  Fax: 843-449-4921

NPI Information:
NPI: 1205810041
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 208600000X





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