Provider Demographics
NPI:1942278197
Name:DESALVO, JAY FISHER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:FISHER
Last Name:DESALVO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 740550
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70174-0550
Mailing Address - Country:US
Mailing Address - Phone:504-366-7638
Mailing Address - Fax:
Practice Address - Street 1:95 E FAIRWAY DR
Practice Address - Street 2:LAKEVIEW REGIONAL MED CENTER
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7500
Practice Address - Country:US
Practice Address - Phone:985-867-4000
Practice Address - Fax:985-867-4001
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA09220R207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1960829Medicaid
LA1960829Medicaid
LA4J573Medicare ID - Type Unspecified