Provider Demographics
NPI:1821124934
Name:JEBENS, DANIEL HENRY (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HENRY
Last Name:JEBENS
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:PO BOX 2627
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29652-2627
Mailing Address - Country:US
Mailing Address - Phone:864-801-4119
Mailing Address - Fax:864-801-4419
Practice Address - Street 1:703 W WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1307
Practice Address - Country:US
Practice Address - Phone:864-801-4119
Practice Address - Fax:864-801-4419
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0583207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3206Medicaid
SCF62872Medicare UPIN