Provider Demographics
NPI:1568078509
Name:ALEXANDER, JEFF DAVID
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:DAVID
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 WADE HAMPTON BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-1110
Mailing Address - Country:US
Mailing Address - Phone:864-263-3302
Mailing Address - Fax:
Practice Address - Street 1:2724 WADE HAMPTON BLVD STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1110
Practice Address - Country:US
Practice Address - Phone:864-263-3302
Practice Address - Fax:972-323-7607
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42D2185432291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory