Provider Demographics
NPI:1376981290
Name:JAY, CARL RUEBEN JR (DPM)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:RUEBEN
Last Name:JAY
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27031 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-5720
Mailing Address - Country:US
Mailing Address - Phone:248-545-4888
Mailing Address - Fax:
Practice Address - Street 1:27031 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-5720
Practice Address - Country:US
Practice Address - Phone:248-545-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002483213E00000X
TX2227213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist