Provider Demographics
NPI:1255572863
Name:MEHTA, JAY G (DO)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:G
Last Name:MEHTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11340 W BELL RD STE 127
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9335
Mailing Address - Country:US
Mailing Address - Phone:623-225-7546
Mailing Address - Fax:623-225-7548
Practice Address - Street 1:11340 W BELL RD STE 127
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9335
Practice Address - Country:US
Practice Address - Phone:623-225-7546
Practice Address - Fax:623-225-7548
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006512207R00000X, 207N00000X
OH58-003057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ960351Medicaid