Individual
MR. TAYLOR KEITH BAUCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3793 MCDOWELL LN, MEDICAL PARK 2, SUITE 100, LITTLE RIVER, SC 29566
(843) 390-0100
Mailing address
4917 CAMPOBELLO DR, MONROE, NC 28110
(704) 221-6042
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4861
SC
Other
Enumeration date
06/09/2023
Last updated
06/09/2023
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