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General NPI Number Information
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NPI Number | 1225219975
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Entity Type | Individual
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Provider Name | PHILIPPE LOUIS-JACQUES PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/23/2007
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Last Update Date | 04/16/2012
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Provider Practice Location Address
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Address Line | 671 NW 119 STREET
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City | NORTH MIAMI
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State | FL
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Zip | 33168
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Country | US
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Telephone | 305-688-0811
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Fax | 305-688-6304
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Provider Business Mailing Address
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Address Line | 2706 ISLAND DR
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City | MIRAMAR
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State | FL
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Zip | 33023-4606
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Country | US
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Telephone | 954-338-5236
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Fax | 954-338-5236
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9103385
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License Number State | FL
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