Provider Demographics
NPI:1811137722
Name:TZENG, JARVIS ARTHUR (DO)
Entity type:Individual
Prefix:
First Name:JARVIS
Middle Name:ARTHUR
Last Name:TZENG
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 1:428 CHILDERS ST
Mailing Address - Street 2:SUITE 23343
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-9630
Mailing Address - Country:US
Mailing Address - Phone:540-818-5752
Mailing Address - Fax:888-819-9648
Practice Address - Street 1:428 CHILDERS ST
Practice Address - Street 2:SUITE 23343
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-9630
Practice Address - Country:US
Practice Address - Phone:540-818-5752
Practice Address - Fax:888-819-9648
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ005721207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program