Healthcare Provider Details

I. General information

NPI: 1265482426
Provider Name (Legal Business Name): CLAUDE E SAINT-JACQUES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 OLD SYMSONIA RD
BENTON KY
42025-5042
US

IV. Provider business mailing address

617 OLD SYMSONIA RD
BENTON KY
42025-5042
US

V. Phone/Fax

Practice location:
  • Phone: 270-527-2411
  • Fax: 270-527-8734
Mailing address:
  • Phone: 270-527-2411
  • Fax: 270-527-8734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number24325
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: