Healthcare Provider Details

I. General information

NPI: 1922305481
Provider Name (Legal Business Name): EDWARD SIGNOR JR. OPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CHEVES ST SUITE 480
FLORENCE SC
29506-2650
US

IV. Provider business mailing address

800 E CHEVES ST SUITE 480
FLORENCE SC
29506-2650
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-7900
  • Fax: 843-777-7924
Mailing address:
  • Phone: 843-777-7900
  • Fax: 843-777-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number998
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: