Provider Demographics
NPI:1093706541
Name:JAQUES, DAVID PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:JAQUES
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Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8109
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-747-2938
Mailing Address - Fax:314-367-1943
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 8C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-2938
Practice Address - Fax:314-367-1943
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2016-11-14
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Provider Licenses
StateLicense IDTaxonomies
MO2007012289208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1093706541Medicaid