Healthcare Provider Details

I. General information

NPI: 1376567172
Provider Name (Legal Business Name): JAY KLEIN P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 SW 32ND PL SUITE 100
OCALA FL
34471-7863
US

IV. Provider business mailing address

2685 SW 32ND PL SUITE 100
OCALA FL
34471-7863
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-9643
  • Fax: 352-732-2243
Mailing address:
  • Phone: 352-732-9643
  • Fax: 352-732-2243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA3717
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: