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NPI Code Detail

MEDICARE: DOUGLAS LANDRY JARVIS M.D.

MEDICARE:   DOUGLAS LANDRY JARVIS  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207X00000XOrthopaedic Surgery Physician2020-02933NC

General Provider Information

NPI Number : 1194137612
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS LANDRY JARVIS M.D.
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12611 N COMMUNITY HOUSE RD STE 100
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-3817
Country : US
Telephone Number : 704-316-3410
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2014
Last Update Date : 10/26/2020

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