Provider Demographics
NPI:1487702684
Name:JAY ALAN DAVIS, MD
Entity type:Organization
Organization Name:JAY ALAN DAVIS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-306-0050
Mailing Address - Street 1:PO BOX 163296
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78716-3296
Mailing Address - Country:US
Mailing Address - Phone:512-306-0050
Mailing Address - Fax:512-306-0015
Practice Address - Street 1:419 BRADY LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5501
Practice Address - Country:US
Practice Address - Phone:512-306-0050
Practice Address - Fax:512-306-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG77982084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0070QDOtherBCBS GROUP
TX00U97LMedicare ID - Type Unspecified
TX0070QDOtherBCBS GROUP