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General NPI Number Information
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NPI Number | 1265658264
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Entity Type | Individual
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Provider Name | IRIS DIANA IGNACIO MD
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 1594 FREEDOM BLVD STE 202
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City | FLORENCE
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State | SC
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Zip | 29505-6046
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Country | US
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Telephone | 843-644-9696
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Fax | 843-629-7082
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Provider Business Mailing Address
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Address Line | 1594 FREEDOM BLVD STE 202
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City | FLORENCE
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State | SC
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Zip | 29505-6046
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Country | US
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Telephone | 843-644-9696
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Fax | 843-629-7082
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10713
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 31057
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License Number State | SC
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