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General NPI Number Information
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NPI Number | 1114962016
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Entity Type | Organization
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Legal Business Name | JAY S. EDMONDS, JR., MD INC.
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 5 HARRIS CT BLDG T SUITE 103
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City | MONTEREY
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State | CA
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Zip | 93940-5750
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Country | US
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Telephone | 831-375-8880
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Fax | 831-375-8804
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Provider Business Mailing Address
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Address Line | 9 WALTER COLTON DR
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City | MONTEREY
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State | CA
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Zip | 93940-4230
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Country | US
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Telephone | 831-375-8880
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Fax | 831-375-8804
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Authorized Official
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Title or Position | OWNER
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Name | JAY S EDMONDS JR.
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Credential | MD
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Telephone | 831-375-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G55954
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License Number State | CA
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