Provider Demographics
NPI:1083970040
Name:ARTHUR, JAY R (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:R
Last Name:ARTHUR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6969 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2835
Mailing Address - Country:US
Mailing Address - Phone:402-413-7460
Mailing Address - Fax:402-413-7486
Practice Address - Street 1:6969 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2835
Practice Address - Country:US
Practice Address - Phone:402-413-7460
Practice Address - Fax:402-413-7486
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1628363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-0733740-04Medicaid
NE470733740-07Medicaid