Individual
DR. JOHN EVANS STAVRAKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
103 SUM MOR DR, WEST COLUMBIA, SC 29169-4828
(803) 244-9212
Mailing address
PO BOX 1320, LEXINGTON, SC 29071-1320
(803) 244-9212
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
39963
SC
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
39963
SC
Other
Enumeration date
07/28/2006
Last updated
07/13/2016
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