Individual
PHIL D JAQUITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
101 S PLUM ST, VERMILLION, SD 57069-3306
(605) 624-8643
Mailing address
1104 W 8TH ST, YANKTON, SD 57078-3306
(605) 665-7841
(605) 665-0546
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0462
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6822814
—
SD
Enumeration date
08/02/2005
Last updated
08/13/2010
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