Individual
DR. DEREK PRAINORUT JAKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1210 W FARIS RD, GREENVILLE, SC 29605-4444
(864) 522-1800
(864) 522-1806
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8614
(803) 296-3076
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
27795
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27795
MEDICAL LICENSE
SC
05
—
277952
—
SC
Enumeration date
06/04/2006
Last updated
03/07/2023
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