Healthcare Provider Details

I. General information

NPI: 1356522122
Provider Name (Legal Business Name): JAMES J JAKUBCHAK MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BOILING SPRINGS RD SUITE 2400
SPARTANBURG SC
29303
US

IV. Provider business mailing address

1330 BOILING SPRINGS RD SUITE 2400
SPARTANBURG SC
29303
US

V. Phone/Fax

Practice location:
  • Phone: 864-583-5312
  • Fax: 864-582-1935
Mailing address:
  • Phone: 864-583-5312
  • Fax: 864-582-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: DR. JAMES JOSEPH JAKUBCHAK
Title or Position: M.D.
Credential: M.D.
Phone: 864-583-5312