Provider Demographics
NPI:1285675892
Name:ARVIN, JON ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:ANTHONY
Last Name:ARVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JON
Other - Middle Name:ANTHONY
Other - Last Name:ARVIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1010 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:MC KEE
Mailing Address - State:KY
Mailing Address - Zip Code:40447-7089
Mailing Address - Country:US
Mailing Address - Phone:859-626-7700
Mailing Address - Fax:859-626-7890
Practice Address - Street 1:116 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-8590
Practice Address - Country:US
Practice Address - Phone:606-256-2143
Practice Address - Fax:606-256-9762
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33743207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65905895Medicaid
KY64337439Medicaid
KY65905895Medicaid
KY64337439Medicaid