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General NPI Number Information
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NPI Number | 1548257405
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Entity Type | Individual
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Provider Name | JAY A JOHANNIGMAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 1215 LEE ST
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22908-4504
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Country | US
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Telephone | 434-924-3627
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Fax |
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Provider Business Mailing Address
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Address Line | 340 NORMANDY AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78209-4541
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Country | US
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Telephone | 513-325-2771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | S8193
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 0101269358
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 35-057183
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | 35.057183
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | M-16154
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License Number State | ID
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