MEDICARE: DR. JAY S EDMONDS JR. 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	207Q00000X	Family Medicine Physician	G55954	CA

General Provider Information

NPI Number	:	1619944881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY S EDMONDS JR. MD

Provider Business Mailing Address
First Line	:	5 HARRIS CT BLDG T
Second Line	:	SUITE 103
City	:	MONTEREY
State	:	CA
Zip	:	93940-5750
Country	:	US
Telephone Number	:	831-375-8880
Fax Number	:	831-375-8804

Provider Business Practice Location Address
First Line	:	5 HARRIS CT BLDG T
Second Line	:	SUITE 103
City	:	MONTEREY
State	:	CA
Zip	:	93940-5750
Country	:	US
Telephone Number	:	831-375-8880
Fax Number	:	831-375-8804

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	10/19/2007

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