Mark Lawrence Jacques, M.D.

Primary specialty

Aerospace Medicine PhysicianTaxonomy code 2083A0100X

License

219194 Issued in NY

Practice address

590 Medical Center Road
Fort Cavazos, TX 76544

Phone

(254) 553-6228

NPI assigned

Mar 27, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747094400000",
    "number": "1780702811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 MEDICAL CENTER ROAD",
            "city": "FORT CAVAZOS",
            "state": "TX",
            "postal_code": "76544",
            "telephone_number": "254-553-6228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 MEDICAL CENTER ROAD",
            "city": "FORT CAVAZOS",
            "state": "TX",
            "postal_code": "76544",
            "telephone_number": "254-553-6228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACQUES",
        "first_name": "MARK",
        "middle_name": "LAWRENCE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "NY",
            "license": "219194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David S Iverson, MD
• Myles Iwen, D.M.D.
• Aaron Jackson, M.D.
• Cody Jackson, DO
• Danette M. Jackson, DO
• Woohyuck Jang, DO
• Dae Min Jeon, DDS
• Mallory Jayne Johnson, OD
• Mitchell Johnson
• Stacey Lanette Johnson, D.C.

• Aerospace Medicine Physician in Fort Cavazos, TX
• Providers in Fort Cavazos, TX by specialty
• Aerospace Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.