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Individual

DENISE M JACQUES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
200 PATEWOOD DR, SUITE A120, GREENVILLE, SC 29615-3593
(864) 454-2670
Mailing address
7 INDEPENDENCE PT, SUITE 140, GREENVILLE, SC 29615-4566
(864) 797-6044

Taxonomy

Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
22187
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
221879
SC
Enumeration date
03/22/2006
Last updated
02/05/2008
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