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Organization
DWAYNE ST. JACQUES MD PLLC
Active
Organization
DWAYNE ST. JACQUES MD PLLC
Active
Other names
AZKidsDoc Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DWAYNE MICHAEL ST. JACQUES M.D. (OWNER/PHYSICIAN)
(480) 783-8964
Entity
Organization
Contact information
Practice address
15215 SOUTH 48TH STREET, SUITE 110, PHOENIX, AZ 85044-9375
(480) 783-8964
(480) 783-8967
Mailing address
15215 SOUTH 48TH STREET, SUITE 110, PHOENIX, AZ 85044-9375
(480) 783-8964
(480) 783-8967
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
NULL
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Enumeration date
01/18/2019
Last updated
01/18/2019
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