Individual
DR. DOUGLAS L. JARVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
56218 PARKWAY AVE, SUITE B, ELKHART, IN 46516-9326
(574) 293-0005
(574) 293-0019
Mailing address
56218 PARKWAY AVE, SUITE B, ELKHART, IN 46516-9326
(574) 293-0005
(574) 293-0019
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
02001719A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000109345
ANTHEM BCBS #
IN
05
—
200133490A
—
IN
Enumeration date
07/15/2005
Last updated
07/16/2013
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