Individual
JONATHON DAVID JAQUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3625 W. 65TH STREET, SUITE 100, EDINA, MN 55435
(952) 920-7001
(612) 626-0665
Mailing address
3625 W. 65TH STREET, SUITE 100, EDINA, MN 55435
(952) 920-7001
(952) 345-0472
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
57244
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/21/2010
Last updated
08/22/2014
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