Provider Demographics
NPI:1194720953
Name:GARVIN, GREGORY L (DO)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:GARVIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 WATER SILK DR N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-4310
Mailing Address - Country:US
Mailing Address - Phone:727-201-6523
Mailing Address - Fax:
Practice Address - Street 1:7410 WATER SILK DR N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782
Practice Address - Country:US
Practice Address - Phone:727-201-6523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLO20208000000X
MOR7326208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
29790OtherWELLMARK BC/BS
IA5159863Medicaid
19805OtherIOWA HEALTH SOLUTIONS
034522OtherHEALTH ALLIANCE
IA0131OtherJOHN DEERE HEALTH PLAN
IA5159863Medicaid
034522OtherHEALTH ALLIANCE