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General NPI Number Information
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NPI Number | 1154434439
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Entity Type | Individual
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Provider Name | JACQUES A ROY M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 02/23/2010
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Provider Practice Location Address
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Address Line | 2617 BOLTON BOONE DR SUITE B
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City | DESOTO
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State | TX
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Zip | 75115-2074
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Country | US
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Telephone | 972-709-1781
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Fax | 972-709-1782
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Provider Business Mailing Address
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Address Line | 2617 BOLTON BOONE DR SUITE B
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City | DESOTO
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State | TX
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Zip | 75115-2074
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Country | US
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Telephone | 972-709-1781
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Fax | 972-709-1782
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G6995
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | G6995
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | G6995
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License Number State | TX
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