Provider Demographics
NPI:1295719268
Name:CLAY, JARED G (MD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:G
Last Name:CLAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4102 PINION DR
Mailing Address - Street 2:10 MDG
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-2502
Mailing Address - Country:US
Mailing Address - Phone:719-333-5138
Mailing Address - Fax:719-333-5836
Practice Address - Street 1:4102 PINION DR
Practice Address - Street 2:10 MDG
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-2502
Practice Address - Country:US
Practice Address - Phone:719-333-5138
Practice Address - Fax:719-333-5836
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2018-03-14
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Provider Licenses
StateLicense IDTaxonomies
CAA94014208600000X
CODR-52995208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN