Provider Demographics
NPI:1760431571
Name:A R JAYARAM MD A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:A R JAYARAM MD A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ATTIGUPAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:JAYARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-455-4120
Mailing Address - Street 1:1250 CONCANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-6002
Mailing Address - Country:US
Mailing Address - Phone:925-455-4120
Mailing Address - Fax:925-455-5020
Practice Address - Street 1:1250 CONCANNON BLVD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-6002
Practice Address - Country:US
Practice Address - Phone:925-455-4120
Practice Address - Fax:925-455-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7585207Q00000X
CAA259872084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ217762OtherPTAN
CAA86995Medicare UPIN