Basic Information
| Provider Information | |||||||||
| NPI: | 1821173246 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JARVIS | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 NORTHGATE BLVD | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958341128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169296161 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4700 NORTHGATE BLVD | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958341128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169296161 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | G47577 | CA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.