Healthcare Provider Details

I. General information

NPI: 1104829399
Provider Name (Legal Business Name): JAY R PATTERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 BARRS ST STE 500
JACKSONVILLE FL
32204-4746
US

IV. Provider business mailing address

562 PARK ST STE 310
JACKSONVILLE FL
32204-2962
US

V. Phone/Fax

Practice location:
  • Phone: 904-388-1820
  • Fax: 904-388-1827
Mailing address:
  • Phone: 904-633-2021
  • Fax: 904-633-9793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME62363
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number030852
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: