Provider Demographics
NPI:1861432312
Name:POINDEXTER, JHONJAY THOMAS (MD)
Entity type:Individual
Prefix:
First Name:JHONJAY
Middle Name:THOMAS
Last Name:POINDEXTER
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 1:2100 POWELL STREET
Mailing Address - Street 2:STE 920
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1803
Mailing Address - Country:US
Mailing Address - Phone:510-350-2777
Mailing Address - Fax:
Practice Address - Street 1:600 MARINE BLVD
Practice Address - Street 2:
Practice Address - City:MOSS BEACH
Practice Address - State:CA
Practice Address - Zip Code:94038
Practice Address - Country:US
Practice Address - Phone:650-728-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46370207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE10437Medicare UPIN