Provider Demographics
NPI:1851312433
Name:WEATHERILL, JAY E (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:E
Last Name:WEATHERILL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:4400 W 69TH ST
Practice Address - Street 2:STE. 1500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8170
Practice Address - Country:US
Practice Address - Phone:605-322-5700
Practice Address - Fax:605-322-5704
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD58812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2443474OtherARAZ/ AMERICA'S PPO
SD5881OtherDAKOTACARE
ND12200Medicaid
SD412991047230OtherPREFERRED ONE
NE46022474352Medicaid
SD53262OtherSANFORD HEALTH PLAN
IA0734756Medicaid
SD250978OtherMIDLANDS CHOICE
MN975T5WEOtherCC SYSTEMS/ BLUE PLUS
SD57108C012OtherWPS TRICARE
SD370624200OtherDEPT OF LABOR
SD4993901OtherBLUE CROSS
SDHP67088OtherHEALTHPARTNERS
MN040121002OtherPRIMEWEST
MN942439300Medicaid
SDS101154Medicare PIN