Individual
SAMAI SUPAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
719 OKATIE HWY # 170, OKATIE, SC 29909-3963
(843) 987-7400
(843) 987-5135
Mailing address
154 SPANISH POINT DR, BEAUFORT, SC 29902-6126
(843) 525-6569
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
11283
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11283
STATE LICENSE
SC
Enumeration date
03/21/2006
Last updated
03/10/2020
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