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NPI Code Detail

MEDICARE: DR. JEFFREY M GOLLER M.D.

MEDICARE: DR. JEFFREY M GOLLER M.D.
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
1207P00000XEmergency Medicine Physician13499SC

General Provider Information

NPI Number : 1447252622
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY M GOLLER M.D.
Provider Business Mailing Address
First Line : 109 BEE ST
Second Line : EMERGENCY DEPARTMENT
City : CHARLESTON
State : SC
Zip : 29401-5703
Country : US
Telephone Number : 843-789-6013
Fax Number :
Provider Business Practice Location Address
First Line : 109 BEE ST
Second Line : EMERGENCY DEPARTMENT
City : CHARLESTON
State : SC
Zip : 29401-5703
Country : US
Telephone Number : 843-789-6013
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 06/01/2011

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