Provider Demographics
NPI:1285684415
Name:HOROWITZ, JAY LENARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:LENARD
Last Name:HOROWITZ
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 1:3701 12TH ST N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2255
Mailing Address - Country:US
Mailing Address - Phone:320-258-3090
Mailing Address - Fax:320-258-3095
Practice Address - Street 1:3701 12TH ST N
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2255
Practice Address - Country:US
Practice Address - Phone:320-258-3090
Practice Address - Fax:320-258-3095
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029475207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA101525OtherL&I ID#
WA242719001OtherGROUP HEALTH ID#
WA8198309OtherCRIME VICTIMS OF WA
WA1093921Medicaid
WA141447000OtherUS DEPT OF LABOR
WAHO8211OtherREGENCE BLUE SHIELD OF WA
WA1093921Medicaid
WA141447000OtherUS DEPT OF LABOR