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Individual

DR. JAMIE LYNN JAQUA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
520 MADISON OAK DR, SAN ANTONIO, TX 78258-3912
(210) 297-4050
Mailing address
4535 DRESSLER RD NW, CANTON, OH 44718-2545
(330) 994-4731
(330) 409-8898

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
P6362
TX
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
2010-01200
NC
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
P6362
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4661837281
MYUTMB 4661837281
05
5920138
NC
Enumeration date
08/05/2007
Last updated
03/12/2024
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