Provider Demographics
NPI:1316940356
Name:JARVISE, JAMES (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:JARVISE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 E DERRINGER WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7826
Mailing Address - Country:US
Mailing Address - Phone:480-812-2119
Mailing Address - Fax:
Practice Address - Street 1:1455 W CHANDLER BLVD
Practice Address - Street 2:BLDG A SUITE 4
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6177
Practice Address - Country:US
Practice Address - Phone:482-899-2900
Practice Address - Fax:480-899-0681
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2586363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P92940Medicare UPIN
75582Medicare ID - Type Unspecified