Provider Demographics
NPI:1124116199
Name:TAPPER, JAY B (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:B
Last Name:TAPPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1860
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4054
Practice Address - Fax:682-885-7497
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2280207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N47FOtherBCBSTX GRP PIN
TX134874011Medicaid
TX10029187OtherAMERIGROUP PIN
TX1588922OtherPHS PIN
TX3326977OtherCIGNA PIN
TX134874010Medicaid
1447220850OtherGRP NPI NUMBER
TX125226100OtherFIRSTCARE PIN
TX1640338OtherFIRSTHEALTH PIN
TX140442853Medicaid
TX932103OtherUHC PIN
TX4253144OtherAETNA PIN
TX124061OtherSUPERIOR PIN
TX137345809Medicaid
TX81W574OtherBCBSTX IND PIN
TX1640338OtherFIRSTHEALTH PIN
TX00N47FMedicare PIN
TX125226100OtherFIRSTCARE PIN