Provider Demographics
NPI:1447557830
Name:JACQUES, BRITTANY JUSTINE (DPM)
Entity type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:JUSTINE
Last Name:JACQUES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:BRITTANY
Other - Middle Name:JUSTINE
Other - Last Name:STILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:25 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-1167
Mailing Address - Country:US
Mailing Address - Phone:207-647-6064
Mailing Address - Fax:207-647-6013
Practice Address - Street 1:25 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1167
Practice Address - Country:US
Practice Address - Phone:207-647-6064
Practice Address - Fax:207-647-6013
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD1091213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery