Provider Demographics
NPI:1922305481
Name:SIGNOR, EDWARD JR (OPA-C)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:SIGNOR
Suffix:JR
Gender:M
Credentials:OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E CHEVES ST
Mailing Address - Street 2:SUITE 480
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2650
Mailing Address - Country:US
Mailing Address - Phone:843-777-7900
Mailing Address - Fax:843-777-7924
Practice Address - Street 1:800 E CHEVES ST
Practice Address - Street 2:SUITE 480
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2650
Practice Address - Country:US
Practice Address - Phone:843-777-7900
Practice Address - Fax:843-777-7924
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN998363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical