Dwayne St. Jacques MD PLLC

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

Legal business name

DWAYNE ST. JACQUES MD PLLC

Doing business as

AZKidsDoc Pediatrics

Practice address

15215 South 48TH Street
Suite 110
Phoenix, AZ 85044-9375

Phone

(480) 783-8964

Fax

(480) 783-8967

NPI assigned

Jan 18, 2019

Last updated

Jan 18, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Dwayne Michael St. Jacques, M.D.NPI 1508830803

Title

Owner/Physician

Phone

(480) 783-8964

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• AZKidsDoc Pediatrics Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dwayne Michael St Jacques, MD

  • Pediatrics Physician
  • Phoenix, AZ
  • NPI 1508830803
  Authorized official Same address or phone

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

{
    "created_epoch": "1547769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547769600000",
    "number": "1902370349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15215 SOUTH 48TH STREET",
            "address_2": "SUITE 110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850449375",
            "telephone_number": "480-783-8964",
            "fax_number": "480-783-8967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15215 SOUTH 48TH STREET",
            "address_2": "SUITE 110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850449375",
            "telephone_number": "480-783-8964",
            "fax_number": "480-783-8967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DWAYNE ST. JACQUES MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-18",
        "last_updated": "2019-01-18",
        "status": "A",
        "authorized_official_last_name": "ST. JACQUES",
        "authorized_official_first_name": "DWAYNE",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "480-783-8964",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "424052",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AZKidsDoc Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatric Adolescent Medicine Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Pediatric Adolescent Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.