Provider Demographics
NPI:1528176740
Name:HARVILLE, KEITH L (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:L
Last Name:HARVILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 HARRISON ST STE B
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-6949
Mailing Address - Country:US
Mailing Address - Phone:870-793-3339
Mailing Address - Fax:870-307-0042
Practice Address - Street 1:701 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2936
Practice Address - Country:US
Practice Address - Phone:501-224-1690
Practice Address - Fax:501-978-7233
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152734001Medicaid
ARH83691Medicare UPIN