Healthcare Provider Details

I. General information

NPI: 1205399672
Provider Name (Legal Business Name): JARROD JAMES WURM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4919 DIERKER RD
COLUMBUS OH
43220-2946
US

IV. Provider business mailing address

4919 DIERKER RD
COLUMBUS OH
43220-2946
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-4952
  • Fax: 614-457-5982
Mailing address:
  • Phone: 614-457-4952
  • Fax: 614-457-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35144275
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: