Provider Demographics
NPI:1831201193
Name:CALVERT, JAY (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:CALVERT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 940249
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93094-0249
Mailing Address - Country:US
Mailing Address - Phone:805-581-5575
Mailing Address - Fax:805-581-4808
Practice Address - Street 1:465 N ROXBURY DR STE 1001
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4213
Practice Address - Country:US
Practice Address - Phone:310-777-8800
Practice Address - Fax:310-248-6258
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA755732086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H52840Medicare UPIN