Healthcare Provider Details

I. General information

NPI: 1104809300
Provider Name (Legal Business Name): PAUL DAMIAN JARVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14828 GREYHOUND CT STE 190
CARMEL IN
46032-5016
US

IV. Provider business mailing address

8840 COMMERCE PARK PL STE E
INDIANAPOLIS IN
46268-3129
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01034243A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: