Provider Demographics
NPI:1801898531
Name:HARVEY, JIM B (DPM)
Entity type:Individual
Prefix:DR
First Name:JIM
Middle Name:B
Last Name:HARVEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 PORT ARTHUR TER
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4600
Mailing Address - Country:US
Mailing Address - Phone:337-239-1061
Mailing Address - Fax:337-239-1062
Practice Address - Street 1:1108 PORT ARTHUR TER
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4600
Practice Address - Country:US
Practice Address - Phone:337-239-1061
Practice Address - Fax:337-239-1062
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD143R213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1668184Medicaid
LA5W455Medicare ID - Type Unspecified
LAU57813Medicare UPIN