Provider Demographics
NPI:1396754883
Name:GARVIN, JASON GLENN (DO)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:GLENN
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 1:3000 RICHMOND AVE
Mailing Address - Street 2:SUITE 425
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3102
Mailing Address - Country:US
Mailing Address - Phone:713-337-0177
Mailing Address - Fax:
Practice Address - Street 1:3000 RICHMOND AVE
Practice Address - Street 2:SUITE 425
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3102
Practice Address - Country:US
Practice Address - Phone:713-337-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL22712084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203051062OtherTIN
TX8K4678Medicare PIN