Healthcare Provider Details

I. General information

NPI: 1225031420
Provider Name (Legal Business Name): DAVID CLARK GIRVIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 PROGRESS DR SUITE D
BELLEVUE OH
44811-9099
US

IV. Provider business mailing address

1031 PIERCE ST SUITE D
SANDUSKY OH
44870-4669
US

V. Phone/Fax

Practice location:
  • Phone: 419-483-4722
  • Fax: 419-483-3483
Mailing address:
  • Phone: 419-557-5541
  • Fax: 419-557-5542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34006484
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: