Individual
THEODORE STEWART GOURDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
TL37304
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/13/2008
Last updated
11/19/2020
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