Provider Demographics
NPI:1477545887
Name:NEUBAUER, JAY C (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:C
Last Name:NEUBAUER
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 MDG
Mailing Address - Street 2:4102 PINION DR.
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2355 FACULTY DR
Practice Address - Street 2:
Practice Address - City:US AIR FORCE
Practice Address - State:CO
Practice Address - Zip Code:80840-1805
Practice Address - Country:US
Practice Address - Phone:719-333-0533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010389542083A0100X
CODR00547452083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0054745OtherMEDICAL LICENSE
VA0101038954OtherMEDICAL LICENSE