Provider Demographics
NPI:1174010375
Name:JARVIS, JASON (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:JARVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9905 S PENNSYLVANIA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6920
Mailing Address - Country:US
Mailing Address - Phone:480-359-5563
Mailing Address - Fax:
Practice Address - Street 1:9905 S PENNSYLVANIA AVE STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6920
Practice Address - Country:US
Practice Address - Phone:480-359-5563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine