Provider Demographics
NPI:1083373450
Name:BUCHANAN, JARVIS JAMAAR
Entity Type:Individual
Prefix:MR
First Name:JARVIS
Middle Name:JAMAAR
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 JENSON CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-4814
Mailing Address - Country:US
Mailing Address - Phone:817-707-6645
Mailing Address - Fax:
Practice Address - Street 1:2350 JENSON CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-4814
Practice Address - Country:US
Practice Address - Phone:817-707-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health