MEDICARE: DR. DAVID CLARK GIRVIN D.O.

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	207Q00000X	Family Medicine Physician	34006484	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	080115680	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000134862	OTHER	OH	ANTHEM BLUE CROSS BLUE SH
2	07852554500	OTHER	OH	BWC IDENTIFIER

General Provider Information

NPI Number	:	1225031420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID CLARK GIRVIN D.O.

Provider Business Mailing Address
First Line	:	1031 PIERCE ST
Second Line	:	SUITE D
City	:	SANDUSKY
State	:	OH
Zip	:	44870-4669
Country	:	US
Telephone Number	:	419-557-5541
Fax Number	:	419-557-5542

Provider Business Practice Location Address
First Line	:	290 PROGRESS DR
Second Line	:	SUITE D
City	:	BELLEVUE
State	:	OH
Zip	:	44811-9099
Country	:	US
Telephone Number	:	419-483-4722
Fax Number	:	419-483-3483

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/24/2012

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Directions to “ DR. DAVID CLARK GIRVIN D.O.” Practice Location

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