MEDICARE: DR. KENNETH JARVIS DPM

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
1	213E00000X	Podiatrist	0108	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00138284	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497758197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH JARVIS DPM

Provider Business Mailing Address
First Line	:	4333 OASIS VALLEY AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89085-2335
Country	:	US
Telephone Number	:	702-810-1748
Fax Number	:	702-837-8292

Provider Business Practice Location Address
First Line	:	1200 S 4TH ST STE 111
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-1046
Country	:	US
Telephone Number	:	702-810-1748
Fax Number	:	702-837-8292

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/17/2018

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