Individual
DAVID SCOTT EBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 GROVE RD, GREENVILLE, SC 29605-4210
(864) 455-7000
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6307
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2300
SC
363A00000X
Physician Assistant
MPA.2300 PA
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003160404A
—
GA
01
—
1068796
WELLCARE (AFFILIATION)
SC
05
—
2132PA
—
SC
01
—
NPI #
BLUE CHOICE MEDICAID
SC
Enumeration date
03/26/2015
Last updated
05/11/2017
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