Provider Demographics
NPI:1801878178
Name:STORY, JAY C (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:C
Last Name:STORY
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 1:141 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2512
Mailing Address - Country:US
Mailing Address - Phone:972-393-1432
Mailing Address - Fax:
Practice Address - Street 1:580 S DENTON TAP RD
Practice Address - Street 2:#123
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4098
Practice Address - Country:US
Practice Address - Phone:972-462-0762
Practice Address - Fax:972-393-2133
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105307604Medicaid
TX105307605Medicaid
TX105307603Medicaid
TXC22327Medicare UPIN
85C101Medicare ID - Type Unspecified
TX105307603Medicaid
TX105307605Medicaid
TX8L8037Medicare PIN