Individual
DR. MARK S JEANJAQUET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 SINGLETON RIDGE RD, CONWAY, SC 29526-9142
(843) 347-8015
(843) 347-8017
Mailing address
PO BOX 829, CONWAY, SC 29528-0829
(843) 347-8015
(843) 347-8017
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
18065
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180654
—
SC
01
—
20017271
FIRST CHOICE
—
01
—
930045476
MEDICARE RAILROAD
—
Enumeration date
07/07/2006
Last updated
04/30/2008
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