Provider Demographics
NPI:1659378198
Name:JACQUES, LOUIS BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:BERNARD
Last Name:JACQUES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:918 BARRACUDA COVE CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4719
Mailing Address - Country:US
Mailing Address - Phone:410-349-1730
Mailing Address - Fax:
Practice Address - Street 1:7500 SECURITY BLVD
Practice Address - Street 2:MAILSTOP C1-09-06
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-1849
Practice Address - Country:US
Practice Address - Phone:410-786-4512
Practice Address - Fax:410-786-9286
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0036186207Q00000X
VA0101042011207Q00000X
DCMD14879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine