Provider Demographics
NPI:1275592610
Name:DUXIN, JAY ROLAND (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:ROLAND
Last Name:DUXIN
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 1:11995 SINGLETREE LN
Mailing Address - Street 2:STE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:18 JAMES CT
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2988
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0336672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT300003571Medicare PIN
CT300003566Medicare PIN
CT010033667CT09OtherANTHEM BC/BS
CT300001469Medicare ID - Type Unspecified
CTP00373062OtherRAILROAD MEDICARE
CT010033667CT16OtherANTHEM BC/BS
CT010033667CT05OtherANTHEM BC/BS
CT300003572Medicare PIN
CT300003433Medicare PIN
CT010033667CT19OtherANTHEM BC/BS
CTP00388385OtherRAILROAD MEDICARE
CT010033667CT04OtherANTHEM BC/BS
CTP00198613OtherRAILROAD MEDICARE
CT001336678Medicaid
CT300003565Medicare PIN
CTP00259057OtherRAILROAD MEDICARE
CT010033667CT06OtherANTHEM BC/BS
CTF80074Medicare UPIN
CT300003567Medicare PIN