Jacques, Renaldo A
Jacques, Renaldo A is an individual health care provider with primary practice located at 2321 N Wisconsin Avenue , Peoria IL 61603-3172. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Jacques, Renaldo A can be contacted via phone (309) 680-7600.Contact Information
Primary practice address
2321 N Wisconsin Avenue
Peoria IL 61603-3172
Phone: (309) 680-7600
Fax: (309) 676-5506
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 036081670 | Illinois |
Profile Details
| NPI number | 1477528974 |
|---|---|
| LBN Legal business name | Jacques, Renaldo A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 20th, 2006 |
| Last updated | Dec 28th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1477528974 | NPPES |
| Illinois | MEDICAID | 036081670 |
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