Provider Demographics
NPI:1831244540
Name:SEGARRA, JAY THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:THOMAS
Last Name:SEGARRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-539-3356
Mailing Address - Fax:228-539-3225
Practice Address - Street 1:15190 COMMUNITY RD
Practice Address - Street 2:STE 220
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3485
Practice Address - Country:US
Practice Address - Phone:228-539-3356
Practice Address - Fax:228-539-3225
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2014-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS12724207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSE83256Medicare UPIN