Basic Information
| Provider Information | |||||||||
| NPI: | 1235139338 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERVIN | ||||||||
| FirstName: | DEWEY | ||||||||
| MiddleName: | NELSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 E CHEVES ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436625233 | ||||||||
| FaxNumber: | 8436789003 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 E CHEVES ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436625233 | ||||||||
| FaxNumber: | 8436789003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 6970 | SC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 890575P | 01 | N.C. MEDICAID | OTHER | 069703 | 05 | SC | MEDICAID |