Doctor Name: | JAY H MISER |
NPI Number: | 1053439372 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | PA14953 |
Business Practice Address: | 6156 Pony Express Trl Pollock Pines, CA - 957269649 |
Business Phone Number: | 5306446044 |
Business Fax Number: | 5306440125 |
Mailing Address: | 6156 Pony Express Trl, POLLOCK PINES |
State: | CA |
Postal Code: | 957269649 |
Phone Number: | 5306446044 |
Fax Number: | 5306440125 |
NPI Enumeration Date: | 03/26/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA14953 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |