Provider Demographics
NPI:1467473694
Name:RAYMOCK, JAY MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:MICHAEL
Last Name:RAYMOCK
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 1:2730 S VAL VISTA DR STE 187
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1684
Mailing Address - Country:US
Mailing Address - Phone:480-324-0300
Mailing Address - Fax:480-324-0324
Practice Address - Street 1:2730 S VAL VISTA DR STE 187
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1684
Practice Address - Country:US
Practice Address - Phone:480-324-0300
Practice Address - Fax:480-324-0324
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF40832Medicare UPIN
AZ63825Medicare ID - Type Unspecified