Individual
DR. MARK A GAUTHIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 HIGHWAY 17 N, SURFSIDE BEACH, SC 29575-6015
(843) 238-1461
(843) 828-0622
Mailing address
1818 HENDERSON ST, COLUMBIA, SC 29201-2619
(803) 782-4278
(803) 782-3445
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15530
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155307
—
SC
Enumeration date
06/22/2006
Last updated
09/16/2009
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