Provider Demographics
NPI:1225088305
Name:JAY, JONATHAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:K
Last Name:JAY
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 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:352-205-8981
Mailing Address - Fax:352-391-6498
Practice Address - Street 1:1035 PIPER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1449
Practice Address - Country:US
Practice Address - Phone:239-465-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82792208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP303910OtherFREEDOM HEALTH
FL29011OtherBCBS OF FL
FLP01804524OtherCLEAH HEALTH ALLIANCE
FLP01193240OtherRR MEDICARE
FL1193173OtherWELLCARE
FLP01193240OtherRAILROAD MCR
FL263674300Medicaid
FL5137684OtherAETNA
FL8813768OtherCIGNA
FLP01193240OtherRR MEDICARE
FLP01804524OtherCLEAH HEALTH ALLIANCE
FLP00401498Medicare PIN
FLE6198VMedicare PIN
FL8813768OtherCIGNA
FLP303910OtherFREEDOM HEALTH