Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | E-12946 | AR |
Y | 111NI0900X | Internist | E-12946 | AR |
N | 208000000X | Pediatrician | E-12946 | AR |
NPI | 1003278052 |
---|---|
Provider Name | Matthew D Harvison |
First Address | Jonesboro, AR 72403-1960 |
Second Address | Trumann, AR 72472-9602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 10/08/2020 |