Healthcare Provider Details

I. General information

NPI: 1164412052
Provider Name (Legal Business Name): JONATHAN G JAQUES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 LINDALL ST
DANVERS MA
01923-2121
US

IV. Provider business mailing address

75 LINDALL ST
DANVERS MA
01923-2121
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-4400
  • Fax: 978-777-1462
Mailing address:
  • Phone: 978-774-4400
  • Fax: 978-777-1462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number75534
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number75534
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: