Provider Demographics
NPI:1154434439
Name:ROY, JACQUES A (MD)
Entity type:Individual
Prefix:
First Name:JACQUES
Middle Name:A
Last Name:ROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2617 BOLTON BOONE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2074
Mailing Address - Country:US
Mailing Address - Phone:972-709-1781
Mailing Address - Fax:972-709-1782
Practice Address - Street 1:2617 BOLTON BOONE DR
Practice Address - Street 2:SUITE B
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2074
Practice Address - Country:US
Practice Address - Phone:972-709-1781
Practice Address - Fax:972-709-1782
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG6995207P00000X, 207QA0505X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140352946Medicaid
C21376Medicare UPIN
TX8684B9Medicare ID - Type Unspecified