Provider Demographics
NPI:1740251941
Name:DEY, JAYANT (MD)
Entity type:Individual
Prefix:
First Name:JAYANT
Middle Name:
Last Name:DEY
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 1:4250 S EASON BLVD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6549
Mailing Address - Country:US
Mailing Address - Phone:662-377-6275
Mailing Address - Fax:662-377-6299
Practice Address - Street 1:4250 S EASON BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6549
Practice Address - Country:US
Practice Address - Phone:662-377-6275
Practice Address - Fax:662-377-6299
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16727207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122340Medicaid
MS00122340Medicaid
MS460000021Medicare PIN