Organization
DWAYNE ST. JACQUES MD PLLC
Active
Other names
AZKidsDoc Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DWAYNE MICHAEL ST. JACQUES M.D. (OWNER/PHYSICIAN)
(480) 783-8964
Entity
Organization
Contact information
Practice address
15215 SOUTH 48TH STREET, SUITE 110, PHOENIX, AZ 85044-9375
(480) 783-8964
(480) 783-8967
Mailing address
15215 SOUTH 48TH STREET, SUITE 110, PHOENIX, AZ 85044-9375
(480) 783-8964
(480) 783-8967
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
424052
—
AZ
Enumeration date
01/18/2019
Last updated
01/18/2019
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