Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | G6995 | TX |
Y | 207QA0505X | Family Doctor - Adult Medicine | G6995 | TX |
N | 207QG0300X | Family Doctor - Geriatric Medicine | G6995 | TX |
NPI | 1154434439 |
---|---|
Provider Name | Jacques A Roy |
First Address | Desoto, TX 75115-2074 |
Second Address | Desoto, TX 75115-2074 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 23/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140352946 | (05) | TX |
C21376 | (02) |