Individual
DR. WADDELL H GILMORE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
180 WINGO WAY STE 301, MOUNT PLEASANT, SC 29464-1812
(843) 884-0302
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
9782
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
097825
—
SC
05
—
DM0683
—
SC
01
—
P00834851
RAILROAD MEDICARE ID-RSFPN
SC
Enumeration date
09/30/2005
Last updated
09/30/2022
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