Individual
DANIEL MARK JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
317 ST. FRANCIS DRIVE, SUITE 360, GREENVILLE, SC 29601
(864) 232-8118
(864) 370-2740
Mailing address
1025 VERDAE BLVD, SUITE A, GREENVILLE, SC 29607-4032
(864) 242-4683
(864) 240-8104
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
17921
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179210
—
SC
01
—
20051085
RR MEDICARE
SC
Enumeration date
12/08/2005
Last updated
06/17/2015
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