Provider Demographics
NPI:1669442927
Name:SMITH, DANIEL MOUZON JR (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MOUZON
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:GREENVILLE
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:864-797-6198
Practice Address - Street 1:390 KEOWEE SCHOOL RD
Practice Address - Street 2:SENECA
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-6743
Practice Address - Country:US
Practice Address - Phone:864-885-7129
Practice Address - Fax:864-882-7240
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC18070207QH0002X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC180707Medicaid
SCGP4697Medicaid
1669442927OtherNPI
SCG237498303Medicare PIN
SC8768Medicare PIN
SC180707Medicaid