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General NPI Number Information
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NPI Number | 1902845936
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Entity Type | Individual
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Provider Name | MICHAEL R. JARVIS D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | CORNER OF ROUTE N12 AND N7
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City | FORT DEFIANCE
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State | AZ
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Zip | 86504
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Country | US
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Telephone | 928-729-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 4047 SALADIN DR SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6249
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Country | US
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Telephone | 616-949-5342
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Fax | 616-949-0071
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MJ007129
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License Number State | MI
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