Provider Demographics
NPI:1053439372
Name:MISER, JAY H (PA-C)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:H
Last Name:MISER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6156 PONY EXPRESS TRL
Mailing Address - Street 2:
Mailing Address - City:POLLOCK PINES
Mailing Address - State:CA
Mailing Address - Zip Code:95726-9649
Mailing Address - Country:US
Mailing Address - Phone:530-644-6044
Mailing Address - Fax:530-644-0125
Practice Address - Street 1:6156 PONY EXPRESS TRL
Practice Address - Street 2:
Practice Address - City:POLLOCK PINES
Practice Address - State:CA
Practice Address - Zip Code:95726-9649
Practice Address - Country:US
Practice Address - Phone:530-644-6044
Practice Address - Fax:530-644-0125
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14953363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP46477Medicare UPIN