Individual
JACK ANDREW HARVEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M
Contact information
Practice address
1234 E NORTH ST, STE 106, MANTECA, CA 95336-4961
(209) 823-2700
Mailing address
1234 E NORTH ST, STE 106, MANTECA, CA 95336-4961
(209) 823-2700
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
E-5204
CA
213EP1101X
Primary Podiatric Medicine Podiatrist
E-5204
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E5204
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/09/2012
Last updated
08/17/2016
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