Provider Demographics
NPI:1841251477
Name:JARVIS, DAVID WARD (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WARD
Last Name:JARVIS
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 1:3901 N ROXBORO ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2181
Mailing Address - Country:US
Mailing Address - Phone:919-479-4160
Mailing Address - Fax:919-479-4116
Practice Address - Street 1:3901 N ROXBORO ST
Practice Address - Street 2:SUITE 301
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2181
Practice Address - Country:US
Practice Address - Phone:919-479-4160
Practice Address - Fax:919-479-4116
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21497363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCR77897Medicare UPIN
NC2746296BMedicare ID - Type Unspecified