Provider Demographics
NPI:1205399672
Name:WURM, JARROD JAMES
Entity type:Individual
Prefix:
First Name:JARROD
Middle Name:JAMES
Last Name:WURM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4919 DIERKER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2946
Mailing Address - Country:US
Mailing Address - Phone:614-457-4952
Mailing Address - Fax:614-457-5982
Practice Address - Street 1:4919 DIERKER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2946
Practice Address - Country:US
Practice Address - Phone:614-457-4952
Practice Address - Fax:614-457-5982
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35144275208000000X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0494617Medicaid