Provider Demographics
NPI:1629096763
Name:SOUTTER, ALEXANDER DIX (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:DIX
Last Name:SOUTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295A MIDLAND PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5901
Mailing Address - Country:US
Mailing Address - Phone:843-695-2700
Mailing Address - Fax:843-875-4046
Practice Address - Street 1:295A MIDLAND PKWY STE 120
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5901
Practice Address - Country:US
Practice Address - Phone:843-695-2700
Practice Address - Fax:843-875-4046
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC512832086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC512831Medicaid