Individual
MR. JACK B SIZEMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
35 INTERNATIONAL DR, GREENVILLE, SC 29615-4816
(864) 234-7654
(864) 675-1657
Mailing address
35 INTERNATIONAL DR, GREENVILLE, SC 29615-4816
(864) 234-7654
(864) 675-1657
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1549
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1036PA
—
SC
Enumeration date
07/21/2010
Last updated
06/23/2016
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