Individual
KEITH ROBERT SUPERDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 GROVE RD, GREENVILLE, SC 29605-4210
(864) 455-5648
(864) 455-7862
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
85922
SC
207RN0300X
Nephrology Physician
MD049781L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014136400001
—
PA
05
—
PENDING
—
SC
Enumeration date
10/11/2005
Last updated
07/21/2021
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