Provider Demographics
NPI:1104024843
Name:JARVIS, JOHN HEBER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HEBER
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 1:5440 E CALLE DEL MEDIO
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4530
Mailing Address - Country:US
Mailing Address - Phone:602-840-7569
Mailing Address - Fax:
Practice Address - Street 1:5440 E CALLE DEL MEDIO
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4530
Practice Address - Country:US
Practice Address - Phone:602-840-7569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry