Provider Demographics
NPI:1104829399
Name:PATTERSON, JAY R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:R
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:562 PARK ST
Mailing Address - Street 2:STE 310
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-2962
Mailing Address - Country:US
Mailing Address - Phone:904-633-2021
Mailing Address - Fax:904-633-9793
Practice Address - Street 1:1801 BARRS ST
Practice Address - Street 2:STE 500
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4746
Practice Address - Country:US
Practice Address - Phone:904-388-1820
Practice Address - Fax:904-388-1827
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME62363207RC0001X
GA030852207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL212236OtherAVMED
FL371127701Medicaid
FL4328516OtherAETNA
GA67555OtherBCBS
GA00518075AMedicaid
GA00518075BMedicaid
FL15092OtherBCBS
GA00518075BMedicaid
GA00518075AMedicaid
GA67555OtherBCBS
FL371127701Medicaid