Provider Demographics
NPI:1295763258
Name:JHUNJHUNWALA, JAY P (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:P
Last Name:JHUNJHUNWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-767-1156
Mailing Address - Fax:225-767-5980
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-767-1156
Practice Address - Fax:225-767-5980
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05762R174400000X
LAMD.05762R208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00019810Medicaid
LA1323799Medicaid
MS00019810Medicaid
LA1323799Medicaid
LA52955DX80Medicare PIN