Individual
ELIZABETH S GORDINEER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
100 RIDGE MEDICAL PLAZA RD, SUITE 102, EDGEFIELD, SC 29824-4535
(803) 637-3630
(803) 637-5348
Mailing address
100 RIDGE MEDICAL PLAZA RD, SUITE 102, EDGEFIELD, SC 29824-4530
(803) 637-3630
(803) 637-5348
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17069
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
170692
—
SC
Enumeration date
12/11/2006
Last updated
02/05/2009
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