Provider Demographics
NPI:1710415021
Name:JAY, JOHN TANNER (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TANNER
Last Name:JAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 WEKIVA COMMONS CIR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-3645
Mailing Address - Country:US
Mailing Address - Phone:407-464-9516
Mailing Address - Fax:407-464-9519
Practice Address - Street 1:515 WEKIVA COMMONS CIR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-3645
Practice Address - Country:US
Practice Address - Phone:407-464-9516
Practice Address - Fax:407-464-9519
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16361207R00000X
NY320438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine