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General NPI Number Information
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NPI Number | 1477640647
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Entity Type | Individual
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Provider Name | DAVID DWIGHT GOLTRA JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 582 LONE TREE DRIVE 582 LONG POINT RD
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City | MT PLEASANT
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State | SC
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Zip | 29464
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Country | US
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Telephone | 843-352-0674
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Fax | 843-971-8832
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Provider Business Mailing Address
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Address Line | 582 LONE TREE DRIVE 582 LONG POINT ROAD
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City | FLORENCE
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State | SC
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Zip | 29501-0523
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Country | US
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Telephone | 843-352-0674
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Fax | 843-971-8832
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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 | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 14764
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License Number State | SC
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