Provider Demographics
NPI:1942237714
Name:KOONS, JAY CLYDE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:CLYDE
Last Name:KOONS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:4645 NW 8TH AVE
Mailing Address - Street 2:INTERVENTIONAL CARDIOLOGISTS OF GAINESVILLE
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4524
Mailing Address - Country:US
Mailing Address - Phone:352-331-8570
Mailing Address - Fax:352-331-9095
Practice Address - Street 1:4645 NW 8TH AVE
Practice Address - Street 2:INTERVENTIONAL CARDIOLOGISTS OF GAINESVILLE
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4524
Practice Address - Country:US
Practice Address - Phone:352-331-8570
Practice Address - Fax:352-331-9095
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME55736207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCM8550OtherMEDICARE RR
FL377799500Medicaid
FL26952OtherBLUECROSS FL
E87614Medicare UPIN
FL377799500Medicaid