Healthcare Provider Details

I. General information

NPI: 1528291218
Provider Name (Legal Business Name): JIMS D. JEAN-JACQUES D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 02/15/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 BROADWAY CARDIOLOGY DEPARTMENT
BANGOR ME
04401-3985
US

IV. Provider business mailing address

PO BOX 7291
LEWISTON ME
04243-7291
US

V. Phone/Fax

Practice location:
  • Phone: 207-907-1770
  • Fax: 207-907-3675
Mailing address:
  • Phone: 207-777-8941
  • Fax: 207-777-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberDO2708
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: