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General NPI Number Information
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NPI Number | 1699750075
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Entity Type | Individual
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Provider Name | DANIEL MARK JACQUES MD
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Gender | Male
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Dates
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Enumeration Date | 12/08/2005
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Last Update Date | 06/17/2015
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Provider Practice Location Address
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Address Line | 317 ST. FRANCIS DRIVE SUITE 360
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City | GREENVILLE
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State | SC
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Zip | 29601
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Country | US
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Telephone | 864-232-8118
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Fax | 864-370-2740
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Provider Business Mailing Address
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Address Line | 1025 VERDAE BLVD SUITE A
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City | GREENVILLE
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State | SC
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Zip | 29607-4032
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Country | US
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Telephone | 864-242-4683
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Fax | 864-240-8104
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 17921
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License Number State | SC
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