Active NPI
Christopher John Jacques, MD
- Anatomic Pathology & Clinical Pathology Physician
- Greenbrae, CA
National Provider Identifier
1699883314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- A48094
- Practice address
- 250 Bon Air Rd
Greenbrae, CA 94904 - Phone
- (415) 925-7174
- Fax
- (415) 898-0870
- NPI assigned
- Aug 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | A48094 | CA | Primary |
Addresses
Primary practice location
250 Bon Air Rd
Greenbrae, CA 94904
Mailing address
1615 Hill Rd
Ste B
Novato, CA 94947
Phone (415) 898-7649
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A480940 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48094 | CA | MD | General Practice Dentistry |
| A48094 | CA | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699883314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1615 HILL RD",
"address_2": "STE B",
"city": "NOVATO",
"state": "CA",
"postal_code": "94947",
"telephone_number": "415-898-7649",
"fax_number": "415-898-0870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 BON AIR RD",
"city": "GREENBRAE",
"state": "CA",
"postal_code": "94904",
"telephone_number": "415-925-7174",
"fax_number": "415-898-0870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACQUES",
"first_name": "CHRISTOPHER",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "CA",
"license": "A48094",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A480940",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenbrae, CA
- Monica Hurtado Leon
- Jessica Denisse Hurtado Tapia
- Yngvar A Hvistendahl, MD
- Lionel Ventus Ishikawa, PHARMD
- Joseph Jackson
- Amber Lynn Jaeger, M.D.
- James E Shepard Mark C Lambert & Lawrence a Levy PTRS (Shepard Lambert Levy)
- Emma Jamison, M.D.
- Brittany Kaleilani Jang
- Jason Sherman DDS, a Dental Corporation
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.