DWAYNE ST. JACQUES MD PLLC NPI 1902370349

NPI Information

NPI: 1902370349
Provider Name: DWAYNE ST. JACQUES MD PLLC
Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

Address:
15215 SOUTH 48TH STREET
SUITE 110
PHOENIX, AZ
ZIP 85044
Phone: (480) 783-8964
Get Directions

DWAYNE ST. JACQUES MD PLLC is an adolescent medicine pediatrics in Phoenix, AZ. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. DWAYNE ST. JACQUES MD PLLC NPI is 1902370349. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

15215 SOUTH 48TH STREET
SUITE 110
PHOENIX, AZ
ZIP 85044-375
Phone: (480) 783-8964
Fax: (480) 783-8967

The provider's authorized official is Dwayne Michael St. Jacques .
The authorized official title is Owner/physician and has the following contact phone number (480) 783-8964.

The enumeration date for this NPI number is 1/18/2019 and was last updated on 1/18/2019.

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				No
2	2080A0000X	Pediatrics	Adolescent Medicine			Yes

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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