Individual
GREGORY S MENCKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 SINGLETON RIDGE RD, CONWAY, SC 29526-9142
(843) 238-8660
Mailing address
PO BOX 51030, MYRTLE BEACH, SC 29579-0018
(843) 238-8660
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
17301
SC
2085B0100X
Body Imaging Physician
17301
SC
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
17301
SC
2085N0700X
Neuroradiology Physician
17301
SC
2085N0904X
Nuclear Radiology Physician
17301
SC
2085P0229X
Pediatric Radiology Physician
17301
SC
2085R0001X
Radiation Oncology Physician
17301
SC
2085R0202X
Diagnostic Radiology Physician
Primary
17301
SC
2085R0203X
Therapeutic Radiology Physician
17301
SC
2085R0204X
Vascular & Interventional Radiology Physician
17301
SC
2085R0205X
Radiological Physics Physician
17301
SC
2085U0001X
Diagnostic Ultrasound Physician
17301
SC
Other
Enumeration date
12/21/2005
Last updated
11/22/2013
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