MEDICARE: JOHN L JAY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	H0493	TX

General Provider Information

NPI Number	:	1033170196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN L JAY MD

Provider Business Mailing Address
First Line	:	8111 LBJ FWY
Second Line	:	SUITE 835
City	:	DALLAS
State	:	TX
Zip	:	75251-1313
Country	:	US
Telephone Number	:	972-644-3232
Fax Number	:	972-644-3810

Provider Business Practice Location Address
First Line	:	221 W COLORADO BLVD
Second Line	:	SUITE 825
City	:	DALLAS
State	:	TX
Zip	:	75208-2363
Country	:	US
Telephone Number	:	214-942-5222
Fax Number	:	214-942-9366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	12/06/2007

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