Healthcare Provider Details

I. General information

NPI: 1174545669
Provider Name (Legal Business Name): JAY J SEYMOUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BLANCHARD CIR SUITE 200
WHEATON IL
60187-2039
US

IV. Provider business mailing address

7 BLANCHARD CIR SUITE 200
WHEATON IL
60187-2039
US

V. Phone/Fax

Practice location:
  • Phone: 630-510-9009
  • Fax: 630-510-0152
Mailing address:
  • Phone: 630-510-9009
  • Fax: 630-510-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036094246
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: