Provider Demographics
NPI:1568466514
Name:TARVER, JAMES HENRY III (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HENRY
Last Name:TARVER
Suffix:III
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 1:2320 N ORANGE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5501
Mailing Address - Country:US
Mailing Address - Phone:407-303-3638
Mailing Address - Fax:407-303-2882
Practice Address - Street 1:2320 N ORANGE AVE STE 201
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5501
Practice Address - Country:US
Practice Address - Phone:407-303-3638
Practice Address - Fax:407-303-2882
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84068207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06721YMedicare PIN
H54788Medicare UPIN
FL06721XMedicare PIN
FL06721ZMedicare PIN