Provider Demographics
NPI:1780679340
Name:PARKIN, JAY DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:DAVID
Last Name:PARKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HILBORN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1097
Mailing Address - Country:US
Mailing Address - Phone:707-646-5599
Mailing Address - Fax:
Practice Address - Street 1:2500 HILBORN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1097
Practice Address - Country:US
Practice Address - Phone:707-646-5599
Practice Address - Fax:707-646-5571
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2643161205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000012288Medicare ID - Type Unspecified
F04890Medicare UPIN