Provider Demographics
NPI:1659521797
Name:SANCHEZ-RIVERA, JARVIS JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JARVIS
Middle Name:JEFFREY
Last Name:SANCHEZ-RIVERA
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:P.O.B0X 616798
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6788
Mailing Address - Country:US
Mailing Address - Phone:407-447-7120
Mailing Address - Fax:
Practice Address - Street 1:1821 MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-3015
Practice Address - Country:US
Practice Address - Phone:470-754-6380
Practice Address - Fax:877-874-7522
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257539207R00000X
GA88814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG279145196OtherMEDICARE