Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | Q2307 | TX |
N | 208200000X | Surgeon | 036120467 | IL |
N | 208600000X | Surgeon | 036120467 | IL |
N | 208200000X | Surgeon | 55659 | MN |
N | 208600000X | Surgeon | 55659 | MN |
NPI | 1275700288 |
---|---|
Provider Name | Dr. Colleen L Jay |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-4402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2008 |
Last Update Date | 13/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
344007501 | (05) | TX |
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |