Provider Demographics
NPI:1730155615
Name:MULANEY, JAY (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:MULANEY
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 1:814 GRIFFIN ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2440
Mailing Address - Country:US
Mailing Address - Phone:863-686-1010
Mailing Address - Fax:863-688-0096
Practice Address - Street 1:814 GRIFFIN ROAD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2440
Practice Address - Country:US
Practice Address - Phone:863-686-1010
Practice Address - Fax:863-688-0096
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055340207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063671100Medicaid
FL10402OtherBCBS
FL2063160OtherOTHER
B41012Medicare UPIN
B41012Medicare UPIN