Provider Demographics
NPI:1659936953
Name:MCCARVER, JEREMY LAWRENCE (DO)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:LAWRENCE
Last Name:MCCARVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 DOERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3010
Mailing Address - Country:US
Mailing Address - Phone:602-403-9139
Mailing Address - Fax:
Practice Address - Street 1:818 DOERWOOD CT
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-3010
Practice Address - Country:US
Practice Address - Phone:602-403-9139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS170182085R0202X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology