Dwayne St. Jacques Md Pllc
LBN: Dwayne St. Jacques Md Pllc
Dwayne St. Jacques Md Pllc is an health care organization with primary practice located at 15215 South 48Th Street Suite 110, Phoenix AZ 85044-9375. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Adolescent Medicine. Allopathic & Osteopathic Physicians / Adolescent Medicine is the primary health care specialty.
Dwayne St. Jacques Md Pllc can be contacted via phone (480) 783-8964, or through St. Jacques, Dwayne Michael via phone (480) 783-8964.
Contact Information
Primary practice address
15215 South 48Th Street Suite 110
Phoenix AZ 85044-9375
Phone: (480) 783-8964
Fax: (480) 783-8967
Website:
Authorized official contact:
Name: St. Jacques, Dwayne Michael Doctor of Medicine (MD)
Phone: (480) 783-8964
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | ||
| Allopathic & Osteopathic Physicians / Adolescent Medicine | 2080A0000X |
Profile Details
| NPI number | 1902370349 |
|---|---|
| LBN Legal business name | Dwayne St. Jacques Md Pllc |
| DBA Doing business as | |
| Authorized official | St. Jacques, Dwayne Michael Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jan 18th, 2019 |
| Last updated | Jan 18th, 2019 - about 5 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902370349 | NPPES |
| Arizona | MEDICAID | 424052 |
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