Individual
DR. ALFONSO L SANGTIAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8030 MYRTLE TRACE DR, CONWAY, SC 29526-8957
(843) 347-4677
(843) 347-4678
Mailing address
8030 MYRTLE TRACE DR, CONWAY, SC 29526-8957
(843) 347-4677
(843) 347-4678
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
16605
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16605
STATE LICENSE
SC
05
—
166055
—
SC
Enumeration date
08/01/2005
Last updated
09/01/2017
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