Provider Demographics
NPI:1992709364
Name:PHILIPPOSE, JAY M (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:M
Last Name:PHILIPPOSE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:725 GLENWOOD DR
Mailing Address - Street 2:MEMORIAL MEDICAL BLDG E SUITE 488-E
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1163
Mailing Address - Country:US
Mailing Address - Phone:423-697-0621
Mailing Address - Fax:423-622-8716
Practice Address - Street 1:725 GLENWOOD DR
Practice Address - Street 2:MEMORIAL MEDICAL BLDG E SUITE 488-E
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1163
Practice Address - Country:US
Practice Address - Phone:423-697-0621
Practice Address - Fax:423-622-8716
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2023-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN37835207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN37835OtherLICENSE
TNBP 3887013OtherDEA
3889492Medicare ID - Type Unspecified
TN37835OtherLICENSE