Provider Demographics
NPI:1750365227
Name:JAQUES, PAUL B (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:B
Last Name:JAQUES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 QUAIL RD
Mailing Address - Street 2:PO BOX 216
Mailing Address - City:OSTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02655-2024
Mailing Address - Country:US
Mailing Address - Phone:508-428-8242
Mailing Address - Fax:
Practice Address - Street 1:40 QUAIL RD
Practice Address - Street 2:
Practice Address - City:OSTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02655-0216
Practice Address - Country:US
Practice Address - Phone:508-428-8242
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA26211207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine