DWAYNE ST. JACQUES MD PLLC (NPI# 1902370349) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1902370349 |
Entity Type | Organization |
Organization Name | DWAYNE ST. JACQUES MD PLLC |
Practice Address |
15215 South 48th Street Suite 110 Phoenix AZ 85044-9375 |
Practice Telephone | 4807838964 |
Practice Fax Number | 4807838967 |
Mailing Telephone | 4807838964 |
Mailing Fax Number | 4807838967 |
Enumeration Date | 2019-01-18 |
Last Update Date | 2019-01-18 |
Authorized Official Name | MR. DWAYNE MICHAEL ST. JACQUES (OWNER/PHYSICIAN) |
Authorized Official Telephone | 4807838964 |
Authorized Official Credential | M.D. |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
AZ | 424052 | 05 |
Other Name | Type Code |
---|---|
AZKidsDoc Pediatrics | Doing Business As Name - Organization |
Street Address |
15215 SOUTH 48TH STREET SUITE 110 |
City | PHOENIX |
State | AZ |
Zip Code | 85044-9375 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023637345 | Jamie Roshun Dawson | Contractor | 13229 S 48th St Apt 3051, Phoenix, AZ 85044 | 2020-04-16 |
1548807514 | The Horizon Chiropractic Center | Clinic/Center | 4425 East Agave Road Suite 104, Phoenix, AZ 85044 | 2019-12-09 |
1134777634 | Elite Therapy of Az | Occupational Therapist | 15245 S 48th Street, Phoenix, AZ 85044 | 2019-08-28 |
1487217584 | Vitae Felix | Psychologist | 5010 E Warner Rd Ste 213, Phoenix, AZ 85044 | 2019-04-16 |
1578082392 | Karena Janiece Herron | Nurse Practitioner | 13625 S 48th St Apt 2100, Phoenix, AZ 85044 | 2017-09-13 |
1053847319 | Amanda Girardi | Dentist | 4726 E Verbena Dr, Phoenix, AZ 85044 | 2017-05-05 |
1518402593 | Janet Swift | Counselor | 10201 South 51st Street; Suite 130, Phoenix, AZ 85044 | 2016-12-29 |
1588074876 | Suzanne Morris | Nurse Practitioner | 4802 E. Ray Rd., Ste 23-364, Phoenix, AZ 85044 | 2014-05-07 |
1891117974 | Dr. Cameron Khavari Pllc | Chiropractor | 4001 E Mountain Sky Ave Ste 101, Phoenix, AZ 85044 | 2014-01-09 |
1316213416 | Shyam Sundar Tangri | Internal Medicine | 13623 S. 45th St, Phoenix, AZ 85044 | 2012-03-22 |
Find all providers in zip 85044 |
Taxonomy Code | 2080A0000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pediatrics |
Specialization | Adolescent Medicine |
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1114271798 | Kristen Marie Buchanan | Pediatrics | 4700 N 51st Ave Ste 4, Phoenix, AZ 85031-1237 | 2012-11-02 |
1295930980 | Mary Ellen Rimsza | Pediatrics | 518 S 3rd St, Phoenix, AZ 85004-2506 | 2007-06-20 |
1508957101 | John Curley | Pediatrics | 4434 N 12th St, Phoenix, AZ 85014-4507 | 2006-09-27 |
1780775395 | Shannon Forshey | Pediatrics | 4434 N 12th Street, Phoenix, AZ 85014-1101 | 2006-09-27 |
1194816702 | Brad Golner | Pediatrics | 4735 E Union Hills Dr, Phoenix, AZ 85050-3362 | 2006-09-27 |
1134473515 | Lizzette Pagan Pllc | Pediatrics | 1823 E Mcdowell Rd, Phoenix, AZ 85006-3052 | 2012-11-06 |
1831373562 | Agnes Ida Bartha | Pediatrics | 7010 E Chauncey Ln, Suite 225, Phoenix, AZ 85054-3111 | 2007-12-17 |
1497964449 | Arizona Pediatric Clinics Pllc | Pediatrics | 809 E Washington St, Suite 106, Phoenix, AZ 85034-1052 | 2007-05-22 |
1053491316 | Anthony Nagorka | Pediatrics | 4434 N 12th Street, Phoenix, AZ 85014-1101 | 2006-10-17 |
1801985486 | The Phoenix Children's Center, Ltd | Pediatrics | 5040 N 15th Ave, Ste 104, Phoenix, AZ 85015-3328 | 2006-10-12 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.