Healthcare Provider Details

I. General information

NPI: 1629029509
Provider Name (Legal Business Name): GARY MICHAEL CURTIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 C UNIVERSITY BLVD
N CHARLESTON SC
29406-9149
US

IV. Provider business mailing address

9225 C UNIVERSITY BLVD
N CHARLESTON SC
29406-9149
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-1032
  • Fax: 843-797-8169
Mailing address:
  • Phone: 843-797-1032
  • Fax: 843-797-8169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number8832
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: