Provider Demographics
NPI:1922132414
Name:HERVEY, MICHAEL JEROME II (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JEROME
Last Name:HERVEY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6707 N 19TH AVE
Mailing Address - Street 2:STE 222
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-1106
Mailing Address - Country:US
Mailing Address - Phone:602-283-3668
Mailing Address - Fax:602-258-1710
Practice Address - Street 1:6707 N 19TH AVE
Practice Address - Street 2:STE 222
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1106
Practice Address - Country:US
Practice Address - Phone:602-283-3668
Practice Address - Fax:602-258-1710
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN102880207Q00000X
AZ45042207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine