Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 212693 | MA |
NPI | 1629035183 |
---|---|
Provider Name | Dr. Jayson R. St. Jacques |
First Address | Ludlow, MA 01056-1246 |
Second Address | Springfield, MA 01104-2377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 04/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H88284 | (02) | MA |