Provider Demographics
NPI:1063480168
Name:JEFFREY, JAY RALEIGH (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:RALEIGH
Last Name:JEFFREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7335
Mailing Address - Country:US
Mailing Address - Phone:870-569-8179
Mailing Address - Fax:870-569-8109
Practice Address - Street 1:253 VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7335
Practice Address - Country:US
Practice Address - Phone:870-569-8179
Practice Address - Fax:870-569-8109
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0374208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127204001Medicaid
AR127204001Medicaid
F47750Medicare UPIN