Provider Demographics
NPI:1821013632
Name:DACUS, ELIZABETH NORENE (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:NORENE
Last Name:DACUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9279 MEDICAL PLAZA DR STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9141
Mailing Address - Country:US
Mailing Address - Phone:843-569-2900
Mailing Address - Fax:843-569-7752
Practice Address - Street 1:9279 MEDICAL PLAZA DR STE A
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9141
Practice Address - Country:US
Practice Address - Phone:843-569-2900
Practice Address - Fax:843-569-7752
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28758207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC28758OtherSTATE LICENSE
SC287585Medicaid
SC287585Medicaid
SC28758OtherSTATE LICENSE