MEDICARE: GARVIN DANIEL JR. MSED, HIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	1536	KS

General Provider Information

NPI Number	:	1467965202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARVIN DANIEL JR. MSED, HIS

Provider Business Mailing Address
First Line	:	4106 W 6TH ST STE E
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4625
Country	:	US
Telephone Number	:	785-749-1885
Fax Number	:	785-749-3767

Provider Business Practice Location Address
First Line	:	4106 W 6TH ST STE E
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4625
Country	:	US
Telephone Number	:	785-749-1885
Fax Number	:	785-749-3767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2017
Last Update Date	:	11/15/2017

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