Provider Demographics
NPI:1003855578
Name:DACH, BRIAN WAYNE (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:WAYNE
Last Name:DACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6303
Mailing Address - Fax:
Practice Address - Street 1:727 SE MAIN ST STE 130
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3266
Practice Address - Country:US
Practice Address - Phone:864-454-6560
Practice Address - Fax:864-454-6565
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC747208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00322763OtherRR MEDICARE
SC007478Medicaid
SC576007863132OtherBLUE CHOICE OF SC
SC576007863173OtherBCBS OF SC
SCAA09913640Medicare PIN
SCAA09927951Medicare PIN