Basic Information
| Provider Information | |||||||||
| NPI: | 1326204199 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAYCOX | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | PETER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1653 W CONGRESS PKWY | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129425000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1653 W CONGRESS PKWY | ||||||||
| Address2: | DEPT. OF GRADUATE MEDICAL EDUCATION | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129425495 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2008 | ||||||||
| LastUpdateDate: | 11/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0336.120950 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | 036120950 | IL | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | 036120950 | IL | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.