Provider Demographics
NPI:1063771889
Name:FAY, JILL SARA (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:SARA
Last Name:FAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:SARA
Other - Last Name:PANOSIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2613 ALMOND ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1116
Mailing Address - Country:US
Mailing Address - Phone:541-851-9396
Mailing Address - Fax:541-851-9399
Practice Address - Street 1:2613 ALMOND ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601
Practice Address - Country:US
Practice Address - Phone:541-851-9396
Practice Address - Fax:541-851-9399
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1474512085R0202X
ORMD1871892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology