MEDICARE: DR. WILLIAM R. GAMMON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20322	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164419941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM R. GAMMON MD

Provider Business Mailing Address
First Line	:	101 MCLEOD HEALTH BLVD STE 201
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4477
Country	:	US
Telephone Number	:	843-646-8001
Fax Number	:	843-646-8002

Provider Business Practice Location Address
First Line	:	101 MCLEOD HEALTH BLVD STE 201
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4477
Country	:	US
Telephone Number	:	843-646-8001
Fax Number	:	843-646-8002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	02/15/2021

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