Provider Demographics
NPI:1487659603
Name:SCHORR, JAY IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:IRA
Last Name:SCHORR
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 1:2401 FRIST BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4800
Mailing Address - Country:US
Mailing Address - Phone:772-464-0033
Mailing Address - Fax:772-467-1150
Practice Address - Street 1:2401 FRIST BLVD
Practice Address - Street 2:STE 1
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4800
Practice Address - Country:US
Practice Address - Phone:772-464-0033
Practice Address - Fax:772-467-1150
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041989174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378187900Medicaid
FL378187900Medicaid
FLD56775Medicare UPIN