Provider Demographics
NPI:1255371381
Name:DURHAM, JACK CURTIS JR (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:CURTIS
Last Name:DURHAM
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:7 INDEPENDENCE PT
Mailing Address - Street 2:STE 140
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4566
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:864-797-6195
Practice Address - Street 1:12 MAPLE TREE CT STE 103
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4079
Practice Address - Country:US
Practice Address - Phone:864-315-1300
Practice Address - Fax:864-315-1301
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC9313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC093133Medicaid
SC571004971025OtherBCBS OF SC
SC080170137OtherRR MEDICARE
SC093133Medicaid
SC571004971025OtherBCBS OF SC