Provider Demographics
NPI:1225219975
Name:LOUIS-JACQUES, PHILIPPE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PHILIPPE
Middle Name:
Last Name:LOUIS-JACQUES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4606
Mailing Address - Country:US
Mailing Address - Phone:954-338-5236
Mailing Address - Fax:954-338-5236
Practice Address - Street 1:671 NW 119 STREET
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168
Practice Address - Country:US
Practice Address - Phone:305-688-0811
Practice Address - Fax:305-688-6304
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103385363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001126500Medicaid