Provider Demographics
NPI:1629163274
Name:JARVIS, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
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 1:4 EXECUTIVE CENTER COURT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-9187
Mailing Address - Country:US
Mailing Address - Phone:501-448-0060
Mailing Address - Fax:501-448-0060
Practice Address - Street 1:4 EXECUTIVE CENTER CT
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4487
Practice Address - Country:US
Practice Address - Phone:501-448-0060
Practice Address - Fax:501-448-0060
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR04070014400OtherQUALCHOICE
AR145837001Medicaid
ARP00195423OtherRAILROAD MEDICARE
AR159635526OtherADDITIONAL MEDICAID
ARE3116OtherTRICARE
AR5M121OtherBCBS
AR5M1216738OtherMEDICARE
AR159635526OtherADDITIONAL MEDICAID
AR145837001Medicaid
5M1216738Medicare PIN
ARE3116OtherTRICARE