Healthcare Provider Details

I. General information

NPI: 1194720953
Provider Name (Legal Business Name): GREGORY L GARVIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 WATER SILK DR N
PINELLAS PARK FL
33782
US

IV. Provider business mailing address

7410 WATER SILK DR N
PINELLAS PARK FL
33782-4310
US

V. Phone/Fax

Practice location:
  • Phone: 727-201-6523
  • Fax:
Mailing address:
  • Phone: 727-201-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLO20
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: