Individual
DR. JAY A JOHANNIGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1215 LEE ST, CHARLOTTESVILLE, VA 22908-4504
(434) 924-3627
Mailing address
340 NORMANDY AVE, SAN ANTONIO, TX 78209-4541
(513) 325-2771
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
Primary
0101269358
VA
2086S0102X
Surgical Critical Care Physician
35-057183
OH
2086S0127X
Trauma Surgery Physician
35.057183
OH
2086S0127X
Trauma Surgery Physician
M-16154
ID
2086S0127X
Trauma Surgery Physician
S8193
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0617236
—
OH
05
—
0705017
—
OH
05
—
64860240
—
KY
Enumeration date
10/05/2005
Last updated
08/22/2024
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