Provider Demographics
NPI:1083632053
Name:MARION, JAY MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:MICHAEL
Last Name:MARION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1501 KINGS HWY
Mailing Address - Street 2:DEPARTMENT OF MEDICINE HEMATOLOGY
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-813-1057
Mailing Address - Fax:318-813-1055
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:DEPARTMENT OF MEDICINE HEMATOLOGY
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-813-1057
Practice Address - Fax:318-813-1055
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA15648R207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1463213Medicaid
LA1463213Medicaid
LAA11425Medicare UPIN