Provider Demographics
NPI:1306115001
Name:KEYSTONE, JAY A (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:A
Last Name:KEYSTONE
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 1:365 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-2136
Mailing Address - Country:US
Mailing Address - Phone:707-446-8581
Mailing Address - Fax:707-446-8581
Practice Address - Street 1:365 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-2136
Practice Address - Country:US
Practice Address - Phone:707-446-8581
Practice Address - Fax:707-446-8581
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-26
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29865207K00000X, 207R00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine