Provider Demographics
NPI:1689023160
Name:SIU, JAY (DO)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:SIU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JUN
Other - Middle Name:
Other - Last Name:FU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2525 N VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-3302
Mailing Address - Country:US
Mailing Address - Phone:830-773-8917
Mailing Address - Fax:830-773-1892
Practice Address - Street 1:4018 EL INDIO HWY
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6690
Practice Address - Country:US
Practice Address - Phone:830-872-3460
Practice Address - Fax:830-872-3470
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2899208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS2899OtherTX MEDICAID HEALTHCARE PARTNERSHIP TMHP)
TXS2899OtherTEXAS MEDICAL BOARD