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General NPI Number Information
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NPI Number | 1710246483
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Entity Type | Organization
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Legal Business Name | JAY PEDIATRICS PA
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 14088 ALABAMA ST
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City | JAY
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State | FL
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Zip | 32565-1036
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Country | US
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Telephone | 850-675-4546
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Fax | 850-675-4548
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | JAY
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State | FL
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Zip | 32565-0010
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Country | US
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Telephone | 850-675-4546
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Fax | 850-675-4548
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MARIAN B STEWART
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Credential | MD
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Telephone | 850-675-4546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME68044
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License Number State | FL
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