Healthcare Provider Details

I. General information

NPI: 1700828746
Provider Name (Legal Business Name): JOHN WALTER YORK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PATEWOOD DR STE C300
GREENVILLE SC
29615-6324
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-8272
  • Fax: 864-454-2875
Mailing address:
  • Phone: 864-522-8603
  • Fax: 888-282-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number19262
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: