Provider Demographics
NPI:1467470732
Name:JAY, RICHARD E (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:JAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 LANE 12
Mailing Address - Street 2:NORTH BIG HORN HOSPITAL CLINIC
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-9537
Mailing Address - Country:US
Mailing Address - Phone:307-548-5201
Mailing Address - Fax:307-548-5224
Practice Address - Street 1:1115 LANE 12
Practice Address - Street 2:NORTH BIG HORN HOSPITAL CLINIC
Practice Address - City:LOVELL
Practice Address - State:WY
Practice Address - Zip Code:82431-9537
Practice Address - Country:US
Practice Address - Phone:307-548-5201
Practice Address - Fax:307-548-5224
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8882A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYD61703Medicare UPIN
WY1467470732Medicare UPIN
NED60703Medicare UPIN