MEDICARE: JEFF DAVID ALEXANDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	42D2185432	SC

General Provider Information

NPI Number	:	1568078509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF DAVID ALEXANDER

Provider Business Mailing Address
First Line	:	2724 WADE HAMPTON BLVD STE C
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-1110
Country	:	US
Telephone Number	:	864-263-3302
Fax Number	:

Provider Business Practice Location Address
First Line	:	2724 WADE HAMPTON BLVD STE C
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-1110
Country	:	US
Telephone Number	:	864-263-3302
Fax Number	:	972-323-7607

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2020
Last Update Date	:	09/16/2020

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Directions to “ JEFF DAVID ALEXANDER ” Practice Location

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