Individual
PAUL J JACQUAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2508 E FOX FARM RD STE 1A, CHEYENNE, WY 82007-2559
(307) 635-3618
(307) 635-1442
Mailing address
2508 E FOX FARM RD STE 1A, CHEYENNE, WY 82007-2559
(307) 635-3618
(307) 635-1442
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
471
WY
Other
Enumeration date
04/15/2009
Last updated
04/29/2010
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