DR. DWAYNE MICHAEL ST JACQUES MD NPI 1508830803

NPI Information

NPI: 1508830803
Provider Name: DR. DWAYNE MICHAEL ST JACQUES, MD
Classification: Pediatrics - 208000000X
Entity Type: Individual
Address:
15215 S 48TH ST
SUITE 110
PHOENIX, AZ
ZIP 85044
Phone: (480) 783-8964
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DR. Dwayne Michael St Jacques, MD is a pediatrics in Phoenix, AZ. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. DR. Dwayne Michael St Jacques, MD NPI is 1508830803. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

15215 S 48TH ST
SUITE 110
PHOENIX, AZ
ZIP 85044-142
Phone: (480) 783-8964
Fax: (480) 783-8967

The enumeration date for this NPI number is 2/14/2006 and was last updated on 1/22/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208000000X	Pediatrics		AZ24143	ARIZONA	Yes
2	2080A0000X	Pediatrics	Adolescent Medicine	24143	ARIZONA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	424052	MEDICAID	ARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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