Provider Demographics
NPI:1891718144
Name:LEVY, JAY MAURICE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:MAURICE
Last Name:LEVY
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 1:1163 TRANCAS ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2907
Mailing Address - Country:US
Mailing Address - Phone:707-255-7900
Mailing Address - Fax:707-224-0445
Practice Address - Street 1:1163 TRANCAS ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2907
Practice Address - Country:US
Practice Address - Phone:707-255-7900
Practice Address - Fax:707-224-0445
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-22776207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A32245Medicare UPIN
00C237760Medicare ID - Type Unspecified