MEDICARE: DR. JAY R PATTERSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0001X	Clinical Cardiac Electrophysiology Physician	ME62363	FL
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	030852	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	212236	OTHER	FL	AVMED
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4328516	OTHER	FL	AETNA
4	67555	OTHER	GA	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	15092	OTHER	FL	BCBS
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104829399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY R PATTERSON MD

Provider Business Mailing Address
First Line	:	562 PARK ST
Second Line	:	STE 310
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-2962
Country	:	US
Telephone Number	:	904-633-2021
Fax Number	:	904-633-9793

Provider Business Practice Location Address
First Line	:	1801 BARRS ST
Second Line	:	STE 500
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4746
Country	:	US
Telephone Number	:	904-388-1820
Fax Number	:	904-388-1827

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/24/2014

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Directions to “ DR. JAY R PATTERSON MD” Practice Location

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