Provider Demographics
NPI:1487602470
Name:HARVEY, JERRY L (DO)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:L
Last Name:HARVEY
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 1:15361 HIGHWAY 5
Mailing Address - Street 2:SUITE E
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-5128
Mailing Address - Country:US
Mailing Address - Phone:501-605-9355
Mailing Address - Fax:
Practice Address - Street 1:15361 HIGHWAY 5
Practice Address - Street 2:SUITE E
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-5128
Practice Address - Country:US
Practice Address - Phone:501-605-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AREO182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125608003Medicaid
AR5J444Medicare ID - Type Unspecified
AR125608003Medicaid