Provider Demographics
NPI:1174545669
Name:SEYMOUR, JAY J (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:J
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 BLANCHARD CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2039
Mailing Address - Country:US
Mailing Address - Phone:630-510-9009
Mailing Address - Fax:630-510-0152
Practice Address - Street 1:7 BLANCHARD CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2039
Practice Address - Country:US
Practice Address - Phone:630-510-9009
Practice Address - Fax:630-510-0152
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036094246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0222075OtherBLUE CROSS GROUP NUMBER
IL036094264Medicaid
IL363149833OtherTAX IDENTIFICATION NUMBER
IL3631498336019001OtherCDPG HFS PAYEE ID
IL0222075OtherBLUE CROSS GROUP NUMBER
IL363149833OtherTAX IDENTIFICATION NUMBER
IL3631498336019001OtherCDPG HFS PAYEE ID