Provider Demographics
NPI:1235247404
Name:HARVEY, JAY W (DO)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:W
Last Name:HARVEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 FAIRGROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-9617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2336 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-2007
Practice Address - Country:US
Practice Address - Phone:828-732-5650
Practice Address - Fax:828-732-5651
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6059207Q00000X
NC2024-00903207Q00000X
ALDO1006207Q00000X
CA20A8765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL6059OtherTMB
CAW20A8765AMedicare ID - Type Unspecified
CAI17561Medicare UPIN