Provider Demographics
NPI:1447258413
Name:JARVIS, JAMES OVID (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:OVID
Last Name:JARVIS
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 1:1777 ASHLEY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104
Mailing Address - Country:US
Mailing Address - Phone:270-781-4043
Mailing Address - Fax:270-846-3133
Practice Address - Street 1:1777 ASHLEY CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3339
Practice Address - Country:US
Practice Address - Phone:270-781-4090
Practice Address - Fax:270-781-7534
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64218662Medicaid
KY64218662Medicaid
KYC65347Medicare UPIN