Provider Demographics
NPI:1619078904
Name:DRAEGER, JAY THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:THOMAS
Last Name:DRAEGER
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:PO BOX 4345
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-0017
Mailing Address - Country:US
Mailing Address - Phone:530-677-1112
Mailing Address - Fax:530-677-1190
Practice Address - Street 1:1600 CREEKSIDE DR STE 1300
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3445
Practice Address - Country:US
Practice Address - Phone:916-983-7860
Practice Address - Fax:916-983-8588
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53023207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G530230Medicare ID - Type Unspecified
CAA52414Medicare UPIN