Individual
DR. CHARLES H.M. JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5722 CABIN CREEK RD, DAWES, WV 25054-0000
(304) 595-5006
(304) 595-2054
Mailing address
PO BOX 70, DAWES, WV 25054-0070
(304) 734-2040
(304) 734-2047
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17181
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0053482000
—
WV
Enumeration date
04/13/2006
Last updated
05/21/2020
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