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General NPI Number Information
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NPI Number | 1992728141
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Entity Type | Individual
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Provider Name | YEVGENY EUGENE MIRONER MD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 279 E KENNEDY ST
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City | SPARTANBURG
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State | SC
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Zip | 29302-1912
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Country | US
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Telephone | 864-583-0053
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Fax | 864-583-0390
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Provider Business Mailing Address
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Address Line | PO BOX 6130
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City | SPARTANBURG
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State | SC
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Zip | 29304-6130
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Country | US
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Telephone | 864-583-0053
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Fax | 864-583-0390
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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 | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 200200419
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 184375
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License Number State | SC
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