Provider Demographics
NPI:1609871979
Name:MELLEN, JAY ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ROBERT
Last Name:MELLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3501 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5648
Mailing Address - Country:US
Mailing Address - Phone:480-424-7228
Mailing Address - Fax:480-424-7317
Practice Address - Street 1:3501 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 320
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5648
Practice Address - Country:US
Practice Address - Phone:480-424-7228
Practice Address - Fax:480-424-7317
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2013-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ15628207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ05306OtherPACIFICARE
AZIZ5847OtherHEALTHNET
AZ860361052OtherARIZONA FOUNDATION
AZ860361052OtherTRICARE
AZ250176Medicaid
AZ626805OtherAETNA
AZ860361052OtherHUMANA
AZ860361052OtherPRIVATE HEALTHCARE SYSTEM
AZ860361052OtherCOMMUNITY CARE NETWORK
AZ25017602Medicaid
AZ3251076Medicaid
AZ860361052BOtherFIRST HEALTH PPO
AZAZ0256070OtherBLUE CROSS BLUE SHIELD
AZ15448OtherUNITED HEALTHCARE
AZ4275000OtherCIGNA HEALTH PLAN
AZ860361052OtherTRICARE
AZ25076-001Medicare ID - Type UnspecifiedARIZONA PHYSICIAN IPA
AZ10WCGMZ02Medicare ID - Type Unspecified
AZ100001044Medicare ID - Type UnspecifiedRAILROAD MEDICARE