Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | E-5204 | CA |
N | 222Z00000X | Podiatrist | E-5204 | CA |
N | 213EP1101X | Primary Podiatric Medicine | E-5204 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | E5204 | CA |
NPI | 1033475678 |
---|---|
Provider Name | Jack Andrew Harvey |
First Address | Manteca, CA 95336-4961 |
Second Address | Manteca, CA 95336-4961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 17/08/2016 |