Provider Demographics
NPI:1851049654
Name:LOUIS-JACQUES, MATHIEU CHRISTIAN (PA)
Entity Type:Individual
Prefix:
First Name:MATHIEU
Middle Name:CHRISTIAN
Last Name:LOUIS-JACQUES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1065 NE 125TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5833
Mailing Address - Country:US
Mailing Address - Phone:888-852-6672
Mailing Address - Fax:305-891-4228
Practice Address - Street 1:9218 KIMMER DR STE 200
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6733
Practice Address - Country:US
Practice Address - Phone:303-683-5620
Practice Address - Fax:303-683-5609
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPA.0007859363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant