Individual
JAY SAMUEL JOSEPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1165 S DORA ST BLDG H, UKIAH, CA 95482-8325
(707) 463-3636
(707) 463-2714
Mailing address
1165 S DORA ST BLDG H, UKIAH, CA 95482-8325
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
G74799
CA
2085R0203X
Therapeutic Radiology Physician
G74799
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G747990
—
CA
Enumeration date
10/13/2006
Last updated
11/03/2021
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