Provider Demographics
NPI:1982705042
Name:STINE, JAY C JR (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:C
Last Name:STINE
Suffix:JR
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 1:608 INGRAHAM AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-5619
Mailing Address - Country:US
Mailing Address - Phone:863-422-9562
Mailing Address - Fax:863-421-3246
Practice Address - Street 1:608 INGRAHAM AVENUE
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-5619
Practice Address - Country:US
Practice Address - Phone:863-422-9562
Practice Address - Fax:863-421-3246
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049894700Medicaid
FL04327OtherBCBS NUMBER
FLD50987Medicare UPIN
FL04327YMedicare PIN