| Organization Name: | COASTAL CAROLINA ENT, DO, PA |
| NPI Number: | 1386989028 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WENDY C. PARIS (INSURANCE/BILLING SPECIALIST) |
| Mailing Address: | 110 Highway 17 S Suite 112 - Sundial Center North Myrtle Beach |
| State: | SC US |
| Postal Code: | 295823118 |
| Phone Number: | 8436639090 |
| Fax Number: | 8436639091 |
| NPI Enumeration Date: | 12/06/2012 |
| NPI Last Update Date: | 06/03/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207YS0123X |
| License Number: | DO 1480 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Otolaryngology |
| Taxonomy Specialization: | Facial Plastic Surgery |
| Taxonomy Definition: | An otolaryngologist who specializes in facial plastic surgery. |