St Jacques, Dwayne Michael

St Jacques, Dwayne Michael is an individual health care provider with primary practice located at 15215 S 48Th St Suite 110, Phoenix AZ 85044-9142. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Adolescent Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. St Jacques, Dwayne Michael can be contacted via phone (480) 783-8964.

Contact Information

Primary practice address
15215 S 48Th St Suite 110 Phoenix AZ 85044-9142
Phone: (480) 783-8964
Fax: (480) 783-8967
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X 24143 Arizona
Allopathic & Osteopathic Physicians / Pediatrics 208000000X AZ24143 Arizona

Profile Details

NPI number 1508830803
LBN Legal business name St Jacques, Dwayne Michael
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2006
Last updated Jan 22nd, 2019 - about 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508830803 NPPES
Arizona MEDICAID 424052

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