Healthcare Provider Details

I. General information

NPI: 1760466692
Provider Name (Legal Business Name): SCOTT WILLIAM JARVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 03/25/2024
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 TOWNE CENTER BLVD
VAN WERT OH
45891-9086
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 419-232-2077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.063622
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35063622
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number35063622
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: