Provider Demographics
NPI:1922121466
Name:MOY, JEFFERY FAY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:FAY
Last Name:MOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:FAY
Other - Last Name:MOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1860 HOWE AVE STE 445
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-1073
Mailing Address - Country:US
Mailing Address - Phone:916-454-2345
Mailing Address - Fax:916-457-2667
Practice Address - Street 1:155 15TH ST
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3737
Practice Address - Country:US
Practice Address - Phone:916-375-8981
Practice Address - Fax:916-375-8990
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG53062Medicare UPIN