Provider Demographics
NPI:1619944881
Name:EDMONDS, JAY S JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:S
Last Name:EDMONDS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:5 HARRIS CT BLDG T
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5750
Mailing Address - Country:US
Mailing Address - Phone:831-375-8880
Mailing Address - Fax:831-375-8804
Practice Address - Street 1:5 HARRIS CT BLDG T
Practice Address - Street 2:SUITE 103
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5750
Practice Address - Country:US
Practice Address - Phone:831-375-8880
Practice Address - Fax:831-375-8804
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2007-10-19
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Provider Licenses
StateLicense IDTaxonomies
CAG55954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G559542Medicare PIN
CAE90117Medicare UPIN