Provider Demographics
NPI:1972678779
Name:BOCCHI, JAY A (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:A
Last Name:BOCCHI
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 1:8950 SW NIMBUS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008
Mailing Address - Country:US
Mailing Address - Phone:503-643-7226
Mailing Address - Fax:503-626-5239
Practice Address - Street 1:8950 SW NIMBUS AVENUE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008
Practice Address - Country:US
Practice Address - Phone:503-643-7226
Practice Address - Fax:503-626-5239
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD129372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR117507Medicaid
OR106189Medicare ID - Type Unspecified
OR117507Medicaid