Provider Demographics
NPI:1558351767
Name:JAQUES, JAMES P (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:JAQUES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:2310 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-3602
Practice Address - Country:US
Practice Address - Phone:484-403-7560
Practice Address - Fax:484-403-7561
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB50411207Q00000X
PAOS006263L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1219804Medicaid
NJP00120596OtherRAILROAD MEDICARE
NJP00120596OtherRAILROAD MEDICARE
NJ576864Medicare PIN
NJ1219804Medicaid