Provider Demographics
NPI:1003810458
Name:JAY, MARTHA F (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:F
Last Name:JAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11307 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3411
Mailing Address - Country:US
Mailing Address - Phone:262-241-1919
Mailing Address - Fax:262-241-9046
Practice Address - Street 1:11307 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3411
Practice Address - Country:US
Practice Address - Phone:262-241-1919
Practice Address - Fax:262-241-9046
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32996-020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31810400Medicaid
WI31810400OtherTAX ID
WI31810400Medicaid
WI46220Medicare ID - Type Unspecified