Healthcare Provider Details

I. General information

NPI: 1639199664
Provider Name (Legal Business Name): KENT B SIZEMORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N FANT ST SUITE C
ANDERSON SC
29621-5702
US

IV. Provider business mailing address

109 ESSEX DR
ANDERSON SC
29621-3318
US

V. Phone/Fax

Practice location:
  • Phone: 864-225-7798
  • Fax: 864-260-3952
Mailing address:
  • Phone: 864-512-3850
  • Fax: 864-512-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18291
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier182910
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: