Provider Demographics
NPI:1710246483
Name:JAY PEDIATRICS PA
Entity Type:Organization
Organization Name:JAY PEDIATRICS PA
Other - Org Name:MARIAN B STEWART MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-675-4546
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-0010
Mailing Address - Country:US
Mailing Address - Phone:850-675-4546
Mailing Address - Fax:850-675-4548
Practice Address - Street 1:14088 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565-1036
Practice Address - Country:US
Practice Address - Phone:850-675-4546
Practice Address - Fax:850-675-4548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68044208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
264891884OtherTRICARE
32119OtherBLUE CROSS AND BLUE SHIELD OF FLORIDA
59176907OtherBLUE CROSS AND BLUE SHIELD OF ALABAMA
1206338OtherUNITED HEALTHCARE
1202673OtherCOVENTRY
264891884OtherHUMANA
264891884OtherCHAMPVA
FL251076600Medicaid
4878883OtherCIGNA
5173714OtherAETNA
AL009905570OtherALACAID