MEDICARE: DR. LOUIS BERNARD JACQUES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0036186	MD
2	207Q00000X	Family Medicine Physician	0101042011	VA
3	207Q00000X	Family Medicine Physician	MD14879	DC

General Provider Information

NPI Number	:	1659378198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS BERNARD JACQUES M.D.

Provider Business Mailing Address
First Line	:	918 BARRACUDA COVE CT
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-4719
Country	:	US
Telephone Number	:	410-349-1730
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 SECURITY BLVD
Second Line	:	MAILSTOP C1-09-06
City	:	BALTIMORE
State	:	MD
Zip	:	21244-1849
Country	:	US
Telephone Number	:	410-786-4512
Fax Number	:	410-786-9286

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	11/12/2008

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