Healthcare Provider Details

I. General information

NPI: 1710272661
Provider Name (Legal Business Name): DANIEL GARVIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W 98 HWY
PENSACOLA FL
32512-2111
US

IV. Provider business mailing address

11995 SINGLETREE LN STE 500
EDEN PRAIRIE MN
55344-5349
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-6463
  • Fax:
Mailing address:
  • Phone: 952-595-1100
  • Fax: 612-294-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0102203206
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS18419
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: