Provider Demographics
NPI:1073759684
Name:JARVIS, JOSEPH WILSON
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WILSON
Last Name:JARVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:J
Other - Middle Name:WILSON
Other - Last Name:JARVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:26222 RR 12
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4903
Mailing Address - Country:US
Mailing Address - Phone:512-858-2714
Mailing Address - Fax:
Practice Address - Street 1:26222 RR 12
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4903
Practice Address - Country:US
Practice Address - Phone:512-858-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80292237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2038002-01Medicaid