Healthcare Provider Details

I. General information

NPI: 1740861814
Provider Name (Legal Business Name): MICHEAL JACE TARVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 E 17TH PL
AURORA CO
80045-2570
US

IV. Provider business mailing address

1730 MINOR AVE STE 300
SEATTLE WA
98101-1474
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-6021
  • Fax:
Mailing address:
  • Phone: 206-386-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0071791
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number61645439
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: