Organization
FLORENCE PODIATRY ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DWAYNE A JACOBUS DPM (OWNER)
(843) 679-9090
Entity
Organization
Contact information
Practice address
510 W CHEVES ST, FLORENCE, SC 29501-4448
(843) 679-9090
(843) 679-9080
Mailing address
510 W CHEVES ST, FLORENCE, SC 29501-4448
(843) 679-9090
(843) 679-9080
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP9918
—
SC
05
—
PD5658
—
SC
Enumeration date
09/30/2005
Last updated
05/05/2014
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