Provider Demographics
NPI:1629160973
Name:MILNE, JAY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:L
Last Name:MILNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3800 S NATIONAL AVE
Mailing Address - Street 2:#540
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807
Mailing Address - Country:US
Mailing Address - Phone:417-269-6262
Mailing Address - Fax:417-269-4349
Practice Address - Street 1:3800 S NATIONAL AVE
Practice Address - Street 2:#730
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-269-5536
Practice Address - Fax:417-269-5586
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO27591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11860OtherBLUE CROSS MO
P00372129Medicare PIN
A12526Medicare UPIN