Provider Demographics
NPI:1922132414
Name:HERVEY, MICHAEL JEROME II (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JEROME
Last Name:HERVEY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1300 N 12TH ST STE 620
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2850
Mailing Address - Country:US
Mailing Address - Phone:602-283-3668
Mailing Address - Fax:602-258-1710
Practice Address - Street 1:1300 N 12TH ST STE 620
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2850
Practice Address - Country:US
Practice Address - Phone:602-283-3668
Practice Address - Fax:602-258-1710
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45042207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology