Provider Demographics
NPI:1326196445
Name:DAVIS, JAY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:ALAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:ALAN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:202 ASHWORTH DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4604
Mailing Address - Country:US
Mailing Address - Phone:512-306-0050
Mailing Address - Fax:512-306-0015
Practice Address - Street 1:202 ASHWORTH DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4604
Practice Address - Country:US
Practice Address - Phone:512-306-0050
Practice Address - Fax:512-306-0015
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG77982084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AJ385OtherBCBS SOLO
TX00U97LMedicare ID - Type Unspecified
TX8AJ385OtherBCBS SOLO